Provider Demographics
NPI:1508053265
Name:KAHULUI PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:KAHULUI PHYSICAL THERAPY LLC
Other - Org Name:ACE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:PROBERT
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-873-8478
Mailing Address - Street 1:2395 S KIHEI RD
Mailing Address - Street 2:STE 206
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8635
Mailing Address - Country:US
Mailing Address - Phone:808-873-8478
Mailing Address - Fax:808-874-0501
Practice Address - Street 1:2395 S KIHEI RD
Practice Address - Street 2:STE 206
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8635
Practice Address - Country:US
Practice Address - Phone:808-873-8478
Practice Address - Fax:808-874-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty