NPIMap

Organization Active NPI

Kahului Physical Therapy LLC

  • Physical Therapist
  • Kihei, HI
National Provider Identifier
1508053265
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1859 Issued in HI
Legal business name
KAHULUI PHYSICAL THERAPY LLC
Practice address
2395 S Kihei Rd
Ste 206
Kihei, HI 96753-8635
Phone
(808) 873-8478
Fax
(808) 874-0501
NPI assigned
Sep 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda Probert Eller, PTNPI 1275575573
Title
Owner
Phone
(808) 873-8478

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 1859 HI Primary

Addresses

Primary practice location

2395 S Kihei Rd
Ste 206
Kihei, HI 96753-8635

Mailing address

2395 S Kihei Rd
Ste 206
Kihei, HI 96753-8635
Phone (808) 873-8478

Other names 1

  • Ace Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081118000626 HI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9335218767 Receives reassigned benefits from 4 practitioners
Practice locations: Kihei, HI

National Provider Directory

National Provider Directory

Locations

2395 S Kihei Rd
Ste 206
Kihei, HI 96753
Phone (808) 873-8478

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554336000000",
    "number": "1508053265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2395 S KIHEI RD",
            "address_2": "STE 206",
            "city": "KIHEI",
            "state": "HI",
            "postal_code": "967538635",
            "telephone_number": "808-873-8478",
            "fax_number": "808-874-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2395 S KIHEI RD",
            "address_2": "STE 206",
            "city": "KIHEI",
            "state": "HI",
            "postal_code": "967538635",
            "telephone_number": "808-873-8478",
            "fax_number": "808-874-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAHULUI PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2019-04-04",
        "status": "A",
        "authorized_official_last_name": "ELLER",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "PROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-873-8478",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": "1859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ace Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ace Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kihei, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.