Provider Demographics
NPI:1568650612
Name:MAUKA PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MAUKA PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITHSON-HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RPT,ATC,LMT
Authorized Official - Phone:808-878-6739
Mailing Address - Street 1:PO BOX 1555
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1555
Mailing Address - Country:US
Mailing Address - Phone:808-878-6739
Mailing Address - Fax:808-572-2265
Practice Address - Street 1:333 NAELE RD
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8750
Practice Address - Country:US
Practice Address - Phone:808-878-6739
Practice Address - Fax:808-572-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-801261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI055241-01Medicaid
HIH52191Medicare PIN