Provider Demographics
NPI:1457992547
Name:EMPOWER PHYSICAL THERAPY AND TRAINING LLC
Entity Type:Organization
Organization Name:EMPOWER PHYSICAL THERAPY AND TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITKO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:858-472-1750
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-0051
Mailing Address - Country:US
Mailing Address - Phone:858-472-1750
Mailing Address - Fax:
Practice Address - Street 1:59-735 KANALANI PL
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9528
Practice Address - Country:US
Practice Address - Phone:858-472-1750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty