Provider Demographics
NPI:1245244912
Name:IMPACT SPORTS INC
Entity Type:Organization
Organization Name:IMPACT SPORTS INC
Other - Org Name:ACTION PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-246-0144
Mailing Address - Street 1:4381 KUKUI GROVE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:808-246-0144
Mailing Address - Fax:808-245-5148
Practice Address - Street 1:4381 KUKUI GROVE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-246-0144
Practice Address - Fax:808-245-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
101101Medicare ID - Type Unspecified