Provider Demographics
NPI:1619147543
Name:ORTHOSPORT HAWAII, LLC
Entity type:Organization
Organization Name:ORTHOSPORT HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER - MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-777-5054
Mailing Address - Street 1:5216 HAO PL APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1653
Mailing Address - Country:US
Mailing Address - Phone:808-358-3881
Mailing Address - Fax:808-373-3666
Practice Address - Street 1:5722 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2388
Practice Address - Country:US
Practice Address - Phone:808-373-3555
Practice Address - Fax:808-373-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT24022251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI103533OtherMEDICARE PTAN