Provider Demographics
NPI:1285718940
Name:HOOGASIAN-KLEIN, LISA M (PT,STS)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:HOOGASIAN-KLEIN
Suffix:
Gender:F
Credentials:PT,STS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4310 LOWER HONOAPIILANI RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-9246
Mailing Address - Country:US
Mailing Address - Phone:808-669-0078
Mailing Address - Fax:808-669-0178
Practice Address - Street 1:4310 LOWER HONOAPIILANI RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-9246
Practice Address - Country:US
Practice Address - Phone:808-669-0078
Practice Address - Fax:808-866-9017
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT#19882251X0800X
HIPT17632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49392407Medicaid
HI49392407Medicaid