Provider Demographics
NPI:1538523311
Name:REHABILITATION AND ORTHOPEDIC CENTER OF KAUAI
Entity type:Organization
Organization Name:REHABILITATION AND ORTHOPEDIC CENTER OF KAUAI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:PASAG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS
Authorized Official - Phone:808-495-8668
Mailing Address - Street 1:2-2514 KAUMUALII HWY
Mailing Address - Street 2:211
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-8303
Mailing Address - Country:US
Mailing Address - Phone:808-495-8668
Mailing Address - Fax:808-495-8669
Practice Address - Street 1:2-2514 KAUMUALII HWY
Practice Address - Street 2:211
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8303
Practice Address - Country:US
Practice Address - Phone:808-495-8668
Practice Address - Fax:808-495-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3128261QP2000X
HI3186261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy