Provider Demographics
NPI:1821852880
Name:PACIFIC THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:PACIFIC THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SZOZDA
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:586-246-7937
Mailing Address - Street 1:PO BOX 2607
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-7607
Mailing Address - Country:US
Mailing Address - Phone:586-246-7937
Mailing Address - Fax:
Practice Address - Street 1:330 OHUKAI RD STE 103
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7058
Practice Address - Country:US
Practice Address - Phone:808-385-4867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy