Provider Demographics
NPI:1447314851
Name:LAHAINA PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:LAHAINA PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAMLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAULIEU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-661-5264
Mailing Address - Street 1:180 DICKENSON ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1215
Mailing Address - Country:US
Mailing Address - Phone:808-661-5264
Mailing Address - Fax:808-661-5264
Practice Address - Street 1:180 DICKENSON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1215
Practice Address - Country:US
Practice Address - Phone:808-661-5264
Practice Address - Fax:808-661-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20148404-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH54778Medicare UPIN