NPIMap

Organization Active NPI

Physical Therapy Associates, LLC

  • Orthopedic Physical Therapist
  • Honolulu, HI
National Provider Identifier
1710029012
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
W40062604-01 Issued in HI
Legal business name
PHYSICAL THERAPY ASSOCIATES, LLC
Practice address
770 Kapiolani Blvd
Suite 104
Honolulu, HI 96813-5212
Phone
(808) 596-9446
Fax
(808) 596-9160
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

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

Authorized official

Name
Bryan T. Lee, D.P.T.NPI 1881744225
Title
Co-Owner
Phone
(808) 596-9446

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
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X W40062604-01 HI Primary

Addresses

Primary practice location

770 Kapiolani Blvd
Suite 104
Honolulu, HI 96813-5212

Mailing address

770 Kapiolani Blvd
Suite 104
Honolulu, HI 96813-5212
Phone (808) 596-9446

Other identifiers 2

IdentifierTypeStateIssuer
209006700OtherHIOWCP PROVIDER NUMBER
Z1654OtherHIMDX PROVIDER NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623000338 HI Part B Supplier - Clinic/Group Practice 5496730467 Receives reassigned benefits from 9 practitioners
Practice locations: Honolulu, HI; Waipahu, HI

National Provider Directory

National Provider Directory

Locations

770 Kapiolani Blvd
Ste 104
Honolulu, HI 96813
Phone (808) 596-9446

94-547 Ukee St
Ste 100
Waipahu, HI 96797
Phone (808) 596-9160

Practitioners & affiliated clinicians

Practitioners 12

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1710029012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 KAPIOLANI BLVD",
            "address_2": "SUITE 104",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135212",
            "telephone_number": "808-596-9446",
            "fax_number": "808-596-9160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 KAPIOLANI BLVD",
            "address_2": "SUITE 104",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968135212",
            "telephone_number": "808-596-9446",
            "fax_number": "808-596-9160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "808-596-9446",
        "authorized_official_credential": "D.P.T."
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "HI",
            "license": "W40062604-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP PROVIDER NUMBER",
            "identifier": "209006700",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDX PROVIDER NUMBER",
            "identifier": "Z1654",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.