Provider Demographics
NPI:1518114941
Name:THERAPUTIC FUSION: PHYSICAL THERAPY & WELLNESS, LLC
Entity type:Organization
Organization Name:THERAPUTIC FUSION: PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:AVDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:808-250-5761
Mailing Address - Street 1:161 WAILEA IKE PLACE
Mailing Address - Street 2:C-101
Mailing Address - City:WAILEA
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:808-250-5761
Mailing Address - Fax:808-875-0775
Practice Address - Street 1:161 WAILEA IKE PLACE
Practice Address - Street 2:C-101
Practice Address - City:WAILEA
Practice Address - State:HI
Practice Address - Zip Code:96753
Practice Address - Country:US
Practice Address - Phone:808-250-5761
Practice Address - Fax:808-875-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-2017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty