Provider Demographics
NPI:1972624419
Name:MALAMA PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:MALAMA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:808-779-5623
Mailing Address - Street 1:95-229 HALEPULE PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-6579
Mailing Address - Country:US
Mailing Address - Phone:808-779-5623
Mailing Address - Fax:
Practice Address - Street 1:95-229 HALEPULE PL
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-6579
Practice Address - Country:US
Practice Address - Phone:808-779-5623
Practice Address - Fax:808-440-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 2246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty