Provider Demographics
NPI:1992031330
Name:KAILUA PHYSICAL THERAPY CLINIC, INC
Entity Type:Organization
Organization Name:KAILUA PHYSICAL THERAPY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:808-261-8931
Mailing Address - Street 1:155 HAMAKUA DR STE B
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2849
Mailing Address - Country:US
Mailing Address - Phone:808-261-8931
Mailing Address - Fax:808-261-0301
Practice Address - Street 1:155 HAMAKUA DR STE B
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2849
Practice Address - Country:US
Practice Address - Phone:808-261-8931
Practice Address - Fax:808-261-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI707OtherSTATE OF HAWAII PHYSICAL THERAPIST LICENSE
HI6955OtherMASSAGE THERAPIST