Provider Demographics
NPI:1295827731
Name:WEISS, P.T., INC.
Entity Type:Organization
Organization Name:WEISS, P.T., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-352-6046
Mailing Address - Street 1:1340 LOPAKA PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4538
Mailing Address - Country:US
Mailing Address - Phone:808-396-8908
Mailing Address - Fax:808-396-8089
Practice Address - Street 1:446 KAWAIHAE ST
Practice Address - Street 2:#401
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-5201
Practice Address - Country:US
Practice Address - Phone:808-396-8908
Practice Address - Fax:808-396-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH101238Medicare PIN
HI1679676175Medicare ID - Type UnspecifiedPERSONAL NPI