Provider Demographics
NPI:1942396379
Name:HOLO MUA LLC
Entity Type:Organization
Organization Name:HOLO MUA LLC
Other - Org Name:JERNAILL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JERNAILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-572-4770
Mailing Address - Street 1:PO BOX 4010
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96733-4010
Mailing Address - Country:US
Mailing Address - Phone:808-572-4770
Mailing Address - Fax:
Practice Address - Street 1:135 ALALUANA RD
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7202
Practice Address - Country:US
Practice Address - Phone:808-572-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI973261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy