Provider Demographics
NPI:1548440274
Name:STEADFAST PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:STEADFAST PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JADINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:808-244-3440
Mailing Address - Street 1:99 S MARKET ST STE 104
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2252
Mailing Address - Country:US
Mailing Address - Phone:808-244-3440
Mailing Address - Fax:808-244-3411
Practice Address - Street 1:99 S MARKET ST STE 104
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2252
Practice Address - Country:US
Practice Address - Phone:808-244-3440
Practice Address - Fax:808-244-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA0237014OtherHMSA