| NPI | 1235180811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STACK Owner Manager 808-572-7790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI W6201699001) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-08-22 |