Provider Demographics
NPI:1265056154
Name:MOLOKAI PHYSICAL THERAPY & REHABILITATION LLC
Entity type:Organization
Organization Name:MOLOKAI PHYSICAL THERAPY & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:808-650-2339
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0398
Mailing Address - Country:US
Mailing Address - Phone:808-862-6787
Mailing Address - Fax:808-762-1318
Practice Address - Street 1:109 ALA MALAMA ST UNIT A
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-862-6787
Practice Address - Fax:808-762-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy