Provider Demographics
NPI:1629309331
Name:PAKOLEA LLC
Entity Type:Organization
Organization Name:PAKOLEA LLC
Other - Org Name:BIG ISLAND PHYSICAL THERPAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:KAIULANI RUSSELL
Authorized Official - Last Name:WAIKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-935-5255
Mailing Address - Street 1:PO BOX 6783
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-935-5255
Mailing Address - Fax:808-961-9044
Practice Address - Street 1:740 KILAUEA AVENUE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-935-5255
Practice Address - Fax:808-961-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3052225100000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty