Provider Demographics
NPI:1326156969
Name:WAIPAHU THERAPY CENTER, LLP
Entity Type:Organization
Organization Name:WAIPAHU THERAPY CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL JUSTIN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-391-7678
Mailing Address - Street 1:PO BOX 970277
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-0277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:94-229 WAIPAHU DEPOT ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3031
Practice Address - Country:US
Practice Address - Phone:808-391-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2012-01-19
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
HIH55795Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER