Provider Demographics
NPI:1184131393
Name:808 PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:808 PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-376-5286
Mailing Address - Street 1:1925 KALAKAUA AVE APT 1403
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1811
Mailing Address - Country:US
Mailing Address - Phone:808-376-5286
Mailing Address - Fax:
Practice Address - Street 1:1750 KALAKAUA AVE STE 108
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3700
Practice Address - Country:US
Practice Address - Phone:808-376-5286
Practice Address - Fax:808-946-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-4277261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1972951218Medicaid