Provider Demographics
NPI:1770867749
Name:THERAPY ASSOCIATES KONA LLC
Entity type:Organization
Organization Name:THERAPY ASSOCIATES KONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-322-0141
Mailing Address - Street 1:77-6539 ALII DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2456
Mailing Address - Country:US
Mailing Address - Phone:808-322-0141
Mailing Address - Fax:808-324-0233
Practice Address - Street 1:77-6539 ALII DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2456
Practice Address - Country:US
Practice Address - Phone:808-322-0141
Practice Address - Fax:808-324-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty