Provider Demographics
NPI:1376986877
Name:ISLAND PHYSIO LLC
Entity Type:Organization
Organization Name:ISLAND PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUNIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-551-7730
Mailing Address - Street 1:47-471 KIALUA ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4848
Mailing Address - Country:US
Mailing Address - Phone:808-551-7730
Mailing Address - Fax:808-200-4584
Practice Address - Street 1:47-471 KIALUA ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4848
Practice Address - Country:US
Practice Address - Phone:808-551-7730
Practice Address - Fax:808-200-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI25412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI2541OtherPT LICENSE NUMBER