Provider Demographics
NPI:1831376383
Name:BALANCE CENTERS OF THE PACIFIC, INC
Entity type:Organization
Organization Name:BALANCE CENTERS OF THE PACIFIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:KISSENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-955-8339
Mailing Address - Street 1:600 KAPIOLANI BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5141
Mailing Address - Country:US
Mailing Address - Phone:808-955-8339
Mailing Address - Fax:808-955-9808
Practice Address - Street 1:600 KAPIOLANI BLVD STE 404
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5141
Practice Address - Country:US
Practice Address - Phone:808-955-8339
Practice Address - Fax:808-955-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH54377Medicare PIN