Provider Demographics
NPI:1538792742
Name:CORE SPORTS HONOLULU LLC
Entity type:Organization
Organization Name:CORE SPORTS HONOLULU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-674-1142
Mailing Address - Street 1:599 FARRINGTON HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2028
Mailing Address - Country:US
Mailing Address - Phone:808-674-1142
Mailing Address - Fax:
Practice Address - Street 1:725 KAPIOLANI BLVD STE C103
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6027
Practice Address - Country:US
Practice Address - Phone:808-674-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORE SPORTS ANALYSIS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy