NPIMap

Organization Active NPI

Club Rehab, Inc.

  • Physical Therapy Clinic/Center
  • Kailua Kona, HI
National Provider Identifier
1811092406
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
CLUB REHAB, INC.
Practice address
73-5590 Kauhola St Ste a
Kailua Kona, HI 96740-2610
Phone
(808) 329-7744
Fax
(808) 334-1608
NPI assigned
Sep 14, 2006
Last updated
Jan 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Authorized official

Name
Gordon Thomas DongNPI 1164572236
Title
President
Phone
(808) 329-7744

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 Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

73-5590 Kauhola St Ste a
Kailua Kona, HI 96740-2610

Mailing address

73-5590 Kauhola St Ste a
Kailua Kona, HI 96740-2610
Phone (808) 329-7744

Other practice location 1

75 5699 Kopiko St
Kailua Kona, HI 96740-3651
Phone (808) 329-7744

Other practice location 2

79-7422 Mamalahoa Hwy
Kealakekua, HI 96750-7913
Phone (808) 322-8400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000432 HI Part B Supplier - Clinic/Group Practice 0749193977 Receives reassigned benefits from 16 practitioners
Practice locations: Kailua Kona, HI; Kealakekua, HI

National Provider Directory

National Provider Directory

Locations

73-5590 Kauhola St
Ste A
Kailua Kona, HI 96740

73-5590 Kauhola St
Ste A
Kailua Kona, HI 96740
Phone (808) 329-7744

73-5590 Kauhola St
Ste E
Kailua Kona, HI 96740

73-5619 Kauhola St
Ste 105106
Kailua Kona, HI 96740
Phone (808) 329-7744

79-7422 Mamalahoa Hwy
Kealakekua, HI 96750
Phone (808) 322-8400

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1811092406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73-5590 KAUHOLA ST STE A",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967402610",
            "telephone_number": "808-329-7744",
            "fax_number": "808-334-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73-5590 KAUHOLA ST STE A",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967402610",
            "telephone_number": "808-329-7744",
            "fax_number": "808-334-1608"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 5699 Kopiko St",
            "address_purpose": "LOCATION",
            "city": "Kailua Kona",
            "state": "HI",
            "postal_code": "967403651",
            "country_code": "US",
            "telephone_number": "808-329-7744",
            "fax_number": "808-334-1608",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "79-7422 Mamalahoa Hwy",
            "address_purpose": "LOCATION",
            "city": "Kealakekua",
            "state": "HI",
            "postal_code": "967507913",
            "country_code": "US",
            "telephone_number": "808-322-8400",
            "fax_number": "808-334-1608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLUB REHAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A",
        "authorized_official_last_name": "DONG",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-329-7744"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua Kona, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; 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.