# KAUAI RESTORATIVE SPORTS MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KRSM
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225804511
- **Authorized official:** GISELLE H GREGORIUS MSW, LSW (COS (CHIEF OF OTHER STUFF))
- **Authorized official phone:** (808) 212-5100

## Contact information

- **Practice address:** 2362 KIPUKA ST, KOLOA, HI 96756-9559
- **Practice address phone:** (808) 755-8000
- **Practice address fax:** (707) 806-0234
- **Mailing address:** 2362 KIPUKA ST, KOLOA, HI 96756-9559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PS0010X | Sports Medicine (Emergency Medicine) Physician | — | NULL | Yes |

## Other

- **Enumeration date:** 11/28/2023
- **Last updated:** 11/28/2023