Provider Demographics
NPI:1861721011
Name:MARSHALL H ORR JR MS MPT LLC
Entity type:Organization
Organization Name:MARSHALL H ORR JR MS MPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ORR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS, MPT
Authorized Official - Phone:808-443-4464
Mailing Address - Street 1:PO BOX 1561
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-1561
Mailing Address - Country:US
Mailing Address - Phone:808-443-4464
Mailing Address - Fax:808-961-6986
Practice Address - Street 1:639 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3827
Practice Address - Country:US
Practice Address - Phone:808-443-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 2082261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55558402Medicaid