Provider Demographics
NPI:1275740326
Name:PACIFIC SPORTS & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:PACIFIC SPORTS & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MITSUO
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-955-9000
Mailing Address - Street 1:1481 SOUTH KING ST.REET
Mailing Address - Street 2:327
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2604
Mailing Address - Country:US
Mailing Address - Phone:808-955-9000
Mailing Address - Fax:808-955-9002
Practice Address - Street 1:1481 SOUTH KING ST.REET
Practice Address - Street 2:327
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2604
Practice Address - Country:US
Practice Address - Phone:808-955-9000
Practice Address - Fax:808-955-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty