Provider Demographics
NPI:1710029012
Name:PHYSICAL THERAPY ASSOCIATES, LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-596-9446
Mailing Address - Street 1:770 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5212
Mailing Address - Country:US
Mailing Address - Phone:808-596-9446
Mailing Address - Fax:808-596-9160
Practice Address - Street 1:770 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5212
Practice Address - Country:US
Practice Address - Phone:808-596-9446
Practice Address - Fax:808-596-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW40062604-012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI209006700OtherOWCP PROVIDER NUMBER
HIZ1654OtherMDX PROVIDER NUMBER
HIZ1654OtherMDX PROVIDER NUMBER
HI209006700OtherOWCP PROVIDER NUMBER