Provider Demographics
NPI:1790853174
Name:PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:JEGSEN
Authorized Official - Last Name:MELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-373-4787
Mailing Address - Street 1:850 W HIND DR
Mailing Address - Street 2:SUITE 104 AND 108
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1855
Mailing Address - Country:US
Mailing Address - Phone:808-373-4787
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR
Practice Address - Street 2:SUITE 104 AND 108
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1855
Practice Address - Country:US
Practice Address - Phone:808-373-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDA8455OtherMEDICARE RAILROAD
HIB5797-2OtherHMSA 65C PLUS GROUP
HIZ1610OtherMDX HAWAII NETWORK GROUP
HIB5797-2OtherHMSA GROUP NUMBER
HIB5797-2OtherHMSA QUEST GROUP
HIB5797-2OtherHMSA 65C PLUS GROUP
HI=========OtherHMA INC GROUP
HIB5797-2OtherHMSA GROUP NUMBER
HIDA8455OtherMEDICARE RAILROAD
HIH54447Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER