Provider Demographics
NPI:1508959339
Name:KAUAI INDEPENDENT REHABILITATION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:KAUAI INDEPENDENT REHABILITATION ASSOCIATES, LLC
Other - Org Name:OHANA SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHAAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-335-5808
Mailing Address - Street 1:2-2488 KAUMUALII HWY
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-8311
Mailing Address - Country:US
Mailing Address - Phone:808-335-5808
Mailing Address - Fax:808-335-5808
Practice Address - Street 1:2-2488 KAUMUALII HWY
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8311
Practice Address - Country:US
Practice Address - Phone:808-335-5808
Practice Address - Fax:808-335-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI101203Medicare ID - Type Unspecified