Provider Demographics
NPI:1285730291
Name:MARESCA PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MARESCA PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KUHIO
Authorized Official - Last Name:MARESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, CERT MDT
Authorized Official - Phone:808-284-0824
Mailing Address - Street 1:2258 PALOLO AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3122
Mailing Address - Country:US
Mailing Address - Phone:808-284-0824
Mailing Address - Fax:808-739-0824
Practice Address - Street 1:500 ALA MOANA BLVD
Practice Address - Street 2:SUITE 1-302
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4920
Practice Address - Country:US
Practice Address - Phone:808-284-0824
Practice Address - Fax:808-739-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT - 1588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty