Provider Demographics
NPI:1346304763
Name:BEAULIEU, KAMLA (PT)
Entity Type:Individual
Prefix:
First Name:KAMLA
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 DICKENSON ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1215
Mailing Address - Country:US
Mailing Address - Phone:808-661-5264
Mailing Address - Fax:808-661-5264
Practice Address - Street 1:180 DICKENSON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1215
Practice Address - Country:US
Practice Address - Phone:808-661-5264
Practice Address - Fax:808-661-5264
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07014602Medicaid
HIH54779Medicare UPIN