Provider Demographics
NPI:1487137642
Name:IMOTO MOBILE THERAPY LLC
Entity type:Organization
Organization Name:IMOTO MOBILE THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUHEI
Authorized Official - Middle Name:
Authorized Official - Last Name:IMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-825-0755
Mailing Address - Street 1:PO BOX 89097
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96830-7097
Mailing Address - Country:US
Mailing Address - Phone:808-304-6676
Mailing Address - Fax:808-800-2654
Practice Address - Street 1:120 KAIULANI AVE # KW1011
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-6203
Practice Address - Country:US
Practice Address - Phone:808-304-6676
Practice Address - Fax:808-800-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty