Provider Demographics
NPI:1851486237
Name:OHANA PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:OHANA PHYSICAL THERAPY INC
Other - Org Name:KNIGHT PHYSICAL THERAPY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SUEKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:714-750-4097
Mailing Address - Street 1:13341 GARDEN GROVE BLVD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843
Mailing Address - Country:US
Mailing Address - Phone:714-750-4097
Mailing Address - Fax:714-750-4616
Practice Address - Street 1:13341 GARDEN GROVE BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843
Practice Address - Country:US
Practice Address - Phone:714-750-4097
Practice Address - Fax:714-750-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15831AMedicare ID - Type Unspecified