Provider Demographics
NPI:1831371830
Name:KINESIS HAWAII INC.
Entity type:Organization
Organization Name:KINESIS HAWAII INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRIANTHIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-965-0880
Mailing Address - Street 1:PO BOX 2096
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-2096
Mailing Address - Country:US
Mailing Address - Phone:808-965-0880
Mailing Address - Fax:808-965-0770
Practice Address - Street 1:15-2866 GOVERNMENT MAIN ROAD
Practice Address - Street 2:PAHOA VILLAGE CENTER
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-965-0880
Practice Address - Fax:808-965-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI473261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHKHIMedicare PIN