Provider Demographics
NPI:1972216430
Name:ELEU PHYSICAL THERAPY
Entity type:Organization
Organization Name:ELEU PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-233-9219
Mailing Address - Street 1:46-036 KAM HWY UNIT 5124
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-7711
Mailing Address - Country:US
Mailing Address - Phone:808-233-9219
Mailing Address - Fax:808-444-3744
Practice Address - Street 1:47-388 HUI IWA ST STE 21B
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4416
Practice Address - Country:US
Practice Address - Phone:808-233-9219
Practice Address - Fax:808-444-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI815293Medicaid