Provider Demographics
NPI:1578842787
Name:HOLOMUA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:HOLOMUA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIMABUKURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-389-5365
Mailing Address - Street 1:1735 ALA AMOAMO ST APT B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1771
Mailing Address - Country:US
Mailing Address - Phone:808-389-5365
Mailing Address - Fax:
Practice Address - Street 1:1744 LILIHA ST STE 301
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3115
Practice Address - Country:US
Practice Address - Phone:808-389-5365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1941261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy