Provider Demographics
NPI:1104269083
Name:ALOHA SPORTS MEDICINE AND PHYSICAL THERAPY OF KAUAI
Entity type:Organization
Organization Name:ALOHA SPORTS MEDICINE AND PHYSICAL THERAPY OF KAUAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYPOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-828-1128
Mailing Address - Street 1:4480C HOOKUI RD
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5302
Mailing Address - Country:US
Mailing Address - Phone:808-828-1128
Mailing Address - Fax:808-828-1124
Practice Address - Street 1:4480C HOOKUI RD
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5302
Practice Address - Country:US
Practice Address - Phone:808-828-1128
Practice Address - Fax:808-828-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1811261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy