Provider Demographics
NPI:1245832021
Name:KEOLA MOBILE THERAPY, LLC
Entity type:Organization
Organization Name:KEOLA MOBILE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UYEUNTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MBA
Authorized Official - Phone:808-779-2744
Mailing Address - Street 1:3457 PAWAINA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1356
Mailing Address - Country:US
Mailing Address - Phone:808-779-2744
Mailing Address - Fax:
Practice Address - Street 1:3457 PAWAINA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1356
Practice Address - Country:US
Practice Address - Phone:808-779-2744
Practice Address - Fax:808-855-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty