Provider Demographics
NPI:1063965382
Name:LIVEWELL PHYSICAL THERAPY
Entity type:Organization
Organization Name:LIVEWELL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:206-854-8864
Mailing Address - Street 1:47-675 NUKUPUU ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5510
Mailing Address - Country:US
Mailing Address - Phone:206-854-8864
Mailing Address - Fax:
Practice Address - Street 1:47-675 NUKUPUU ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5510
Practice Address - Country:US
Practice Address - Phone:206-854-8864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2795261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy