Provider Demographics
NPI:1316087315
Name:PORTNER ORTHOPEDIC REHABILITATION INCORPORATED
Entity type:Organization
Organization Name:PORTNER ORTHOPEDIC REHABILITATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:MANSANAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-379-1515
Mailing Address - Street 1:46-001 KAMEHAMEHA HWY STE 109
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3724
Mailing Address - Country:US
Mailing Address - Phone:808-247-7596
Mailing Address - Fax:
Practice Address - Street 1:45-1144 KAMEHAMEHA HWY STE 200
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3226
Practice Address - Country:US
Practice Address - Phone:808-247-9408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4132208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHPOROtherPTAN