Provider Demographics
NPI:1700816980
Name:QUALITY CARE THERAPY, LLC
Entity Type:Organization
Organization Name:QUALITY CARE THERAPY, LLC
Other - Org Name:MOON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:SO
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-550-4774
Mailing Address - Street 1:650 IWILEI RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5086
Mailing Address - Country:US
Mailing Address - Phone:808-550-4774
Mailing Address - Fax:808-550-0097
Practice Address - Street 1:650 IWILEI RD
Practice Address - Street 2:SUITE 265
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5086
Practice Address - Country:US
Practice Address - Phone:808-550-4774
Practice Address - Fax:808-550-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 1843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH56583Medicare ID - Type Unspecified