Provider Demographics
NPI:1346964129
Name:KULEANA PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:KULEANA PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:REISER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-652-5275
Mailing Address - Street 1:66-210 KAMEHAMEHA HWY STE A
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-2408
Mailing Address - Country:US
Mailing Address - Phone:808-726-3837
Mailing Address - Fax:
Practice Address - Street 1:66-210 KAMEHAMEHA HWY STE A
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-2408
Practice Address - Country:US
Practice Address - Phone:808-726-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty