Provider Demographics
NPI:1356573083
Name:PACIFIC SPORTS REHAB,LLC
Entity type:Organization
Organization Name:PACIFIC SPORTS REHAB,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTORATE OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HOWYUE
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-585-7799
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-521-2002
Mailing Address - Fax:888-417-2122
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 801
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-585-7799
Practice Address - Fax:888-417-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI2995OtherHAWAII PHYSICAL THERAPY LICENSE NUMBER