Provider Demographics
NPI:1912010786
Name:LOEWENHERZ, LINDA ROSE (RPT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ROSE
Last Name:LOEWENHERZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ROSE
Other - Last Name:TERPSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-0487
Mailing Address - Country:US
Mailing Address - Phone:808-934-7651
Mailing Address - Fax:808-935-6895
Practice Address - Street 1:333 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3013
Practice Address - Country:US
Practice Address - Phone:808-961-3505
Practice Address - Fax:808-961-6505
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 1266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI24512302Medicaid
HI24512302Medicaid