Kelli Ganiko, PT, DPT, MOT, OTR/L
Individual provider Active NPI Physical Therapist · Wailuku, HI
NPI 1588044853 · NPPES record last updated Mar 21, 2017
Key facts
- NPI
- 1588044853
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-4063 (HI)
- Practice address
- 6 Central Ave
Wailuku, HI 96793-1703 - Phone
- (808) 244-5541
- Fax
- (808) 242-8485
- NPI assigned
- Jun 2, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Elite Physical Therapy and Sports
Practice addresses (Care Compare)
1043 Makawad Ave
Suite 107
Makawao, HI 96768
Phone (808) 572-7790
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in HI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151228002068 | HI | Practitioner - Physical Therapist in Private Practice | 6305147810 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-4063 | HI | MD | Physical Therapist |
| OT1467 | HI | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Venture Physical Therapy LLC | Physical Therapist | Current |
Accepting new patients |
| Venture Physical Therapy LLC | Physical Therapist | Current |
Accepting new patients |
| Elite Physical Therapy and Sports | Physical Therapist | Current |
Accepting new patients |
| Community Clinic of Maui, Inc. | Past | Accepting new patients |
Locations
1043 Makawao Ave
Ste 107
Makawao, HI 96768
Phone (808) 572-7790
6 Central Ave
Wailuku, HI 96793
Phone (808) 244-5541
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-4063 | HI | Yes |
| Occupational Therapist | 225X00000X | OT1467 | HI |
Addresses
Primary practice location
6 Central Ave
Wailuku, HI 96793-1703
Mailing address
6 Central Ave
Wailuku, HI 96793-1703
Phone (808) 244-5541
Other providers in Wailuku, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.