Provider Demographics
NPI:1396337549
Name:SEBASTIAN LLC
Entity type:Organization
Organization Name:SEBASTIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:808-234-9041
Mailing Address - Street 1:1177 LUNALILO HOME RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3204
Mailing Address - Country:US
Mailing Address - Phone:808-497-3775
Mailing Address - Fax:
Practice Address - Street 1:1177 LUNALILO HOME RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3204
Practice Address - Country:US
Practice Address - Phone:808-234-9041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy