NPIMap

Organization Active NPI

Professional Rehab Therapy, LLC

  • Physical Therapist
  • Waipahu, HI
National Provider Identifier
1669612941
Registry record updated Feb 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFESSIONAL REHAB THERAPY, LLC
Practice address
94-229 Waipahu Depot St Ste 301
Waipahu, HI 96797-3033
Phone
(808) 671-7414
Fax
(808) 671-7133
NPI assigned
Feb 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2009

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

Authorized official

Name
Ms. Kathleen I. ClarkNPI 1477785368
Title
Owner/Therapist
Phone
(808) 671-7414

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X HI Primary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X MAT 8855 HI

Addresses

Primary practice location

94-229 Waipahu Depot St Ste 301
Waipahu, HI 96797-3033

Mailing address

94-229 Waipahu Depot St Ste 301
Waipahu, HI 96797-3033
Phone (808) 671-7414

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091028000606 HI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1052458791 Receives reassigned benefits from 3 practitioners
Practice locations: Ewa Beach, HI

National Provider Directory

National Provider Directory

Locations

94-866 Moloalo St
Ste D11B
Waipahu, HI 96797

Practitioners & affiliated clinicians

Practitioners 7

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": "1235692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235692800000",
    "number": "1669612941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94-229 WAIPAHU DEPOT ST STE 301",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967973033",
            "telephone_number": "808-671-7414",
            "fax_number": "808-671-7133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94-229 WAIPAHU DEPOT ST STE 301",
            "city": "WAIPAHU",
            "state": "HI",
            "postal_code": "967973033",
            "telephone_number": "808-671-7414",
            "fax_number": "808-671-7133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL REHAB THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-27",
        "last_updated": "2009-02-27",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "808-671-7414",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "HI",
            "license": "MAT 8855",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waipahu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2009; 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.