Provider Demographics
NPI:1407925753
Name:HAWAII PHYSICAL THERAPY & CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:HAWAII PHYSICAL THERAPY & CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARVELEE
Authorized Official - Middle Name:HEALANI
Authorized Official - Last Name:LEITE - AH YO
Authorized Official - Suffix:
Authorized Official - Credentials:R,PT, DC
Authorized Official - Phone:808-961-5663
Mailing Address - Street 1:261 WAIANUENUE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2438
Mailing Address - Country:US
Mailing Address - Phone:808-961-5663
Mailing Address - Fax:808-969-3767
Practice Address - Street 1:261 WAIANUENUE AVENUE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2438
Practice Address - Country:US
Practice Address - Phone:808-961-5663
Practice Address - Fax:808-969-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC597111N00000X
HIPT742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03304301Medicaid
HI03304301Medicaid
HI0000QCCPDMedicare PIN
U42038Medicare UPIN