Provider Demographics
NPI:1609175132
Name:MANOA THERAPEUTIC CENTER
Entity Type:Organization
Organization Name:MANOA THERAPEUTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BRYONY
Authorized Official - Last Name:PREBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-988-7778
Mailing Address - Street 1:2961 E MANOA RD STE B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-6810
Mailing Address - Country:US
Mailing Address - Phone:808-988-7778
Mailing Address - Fax:
Practice Address - Street 1:2961 E MANOA RD STE B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-6810
Practice Address - Country:US
Practice Address - Phone:808-988-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2342251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare