Provider Demographics
NPI:1558904912
Name:ATTA REHAB, LLC
Entity Type:Organization
Organization Name:ATTA REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-773-8811
Mailing Address - Street 1:98-657 PAPALEALII ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-2755
Mailing Address - Country:US
Mailing Address - Phone:808-773-8811
Mailing Address - Fax:808-495-4418
Practice Address - Street 1:99-115 AIEA HEIGHTS DR STE 253
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3975
Practice Address - Country:US
Practice Address - Phone:808-256-8395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty