Provider Demographics
NPI:1912764796
Name:PHYSIO WELLNESS LLC
Entity Type:Organization
Organization Name:PHYSIO WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KARP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-673-3971
Mailing Address - Street 1:422 ILIMANO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1827
Mailing Address - Country:US
Mailing Address - Phone:808-673-3971
Mailing Address - Fax:
Practice Address - Street 1:422 ILIMANO ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1827
Practice Address - Country:US
Practice Address - Phone:808-673-3971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy