Provider Demographics
NPI:1609332972
Name:MAUKA MOVEMENT LLC
Entity Type:Organization
Organization Name:MAUKA MOVEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NESSVIG
Authorized Official - Last Name:VANHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:608-347-4986
Mailing Address - Street 1:81-965 HALEKII ST STE C
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-8164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81-965 HALEKII ST STE C
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8164
Practice Address - Country:US
Practice Address - Phone:606-347-4986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy