Provider Demographics
NPI:1801245378
Name:MAUI HOLISTIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MAUI HOLISTIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGNHILD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-269-2972
Mailing Address - Street 1:PO BOX 901559
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-1559
Mailing Address - Country:US
Mailing Address - Phone:808-269-2972
Mailing Address - Fax:808-878-1879
Practice Address - Street 1:5281 LOWER KULA RD
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-7712
Practice Address - Country:US
Practice Address - Phone:808-269-2972
Practice Address - Fax:808-878-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty