Haleiwa Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

3261 Issued in HI

Legal business name

HALEIWA PHYSICAL THERAPY LLC

Practice address

66-590 Kamehameha Hwy Ste. 2F
Haleiwa, HI 96712

Phone

(808) 647-0112

NPI assigned

Feb 5, 2016

Organization subpart

No

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

Authorized official

Name

Kevin J Fowler, MPTNPI 1902119621

Title

Owner

Phone

(808) 260-7210

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Haleiwa Physical Therapy Former legal business name

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Locations

Practitioners 6

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

• Kevin Joseph Fowler, MPT

  • Orthopedic Physical Therapist
  • Waipahu, HI
  • NPI 1902119621
  Medicare reassignment Care Compare group NPD Authorized official
• Stephanie Colasanti

  • Physical Therapist
  • Kailua Kona, HI
  • NPI 1083163471
  Medicare reassignment Care Compare group NPD
• April Mae Malon Tiu, DPT

  • Physical Therapist
  • Midland, TX
  • NPI 1033830740

  HI

  Medicare reassignment Care Compare group NPD
• Jacquelyn Victoria Vaughan Reiser, D.P.T.

  • Orthopedic Physical Therapist
  • Haleiwa, HI
  • NPI 1336586106
  Medicare reassignment NPD
• Lee Dressler

  • Physical Therapist
  • Cullman, AL
  • NPI 1265025738

  HI

  Medicare reassignment NPD
• Ximena E Wunderlich, LMT

  • Massage Therapist
  • Haleiwa, HI
  • NPI 1932666724
  NPD (past)

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

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1902264955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66-590 KAMEHAMEHA HWY STE. 2F",
            "city": "HALEIWA",
            "state": "HI",
            "postal_code": "96712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66-590 KAMEHAMEHA HWY STE. 2F",
            "city": "HALEIWA",
            "state": "HI",
            "postal_code": "96712",
            "telephone_number": "808-647-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALEIWA PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-05",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "808-260-7210",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "HI",
            "license": "3261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902119621",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haleiwa Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Haleiwa Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Erin Yamamoto Gove, LCSW
• Tiare Gras, RN
• Haleiwa Chiropractic Clinic, Inc.
• Haleiwa Family Clinic, Inc.
• Haleiwa Family Dental Center, LTD.
• Heather Jablonski, LCSW LLC
• Niv Hemi, LMT
• James Russell Henrie, PHD.
• Belma Cortes Hernandez, PHARMACIST
• Ho'Ola NA Pua

• Physical Therapy Clinic/Center in Haleiwa, HI
• Providers in Haleiwa, HI by specialty
• Physical Therapy Clinic/Center in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.