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Organization
ELITE PHYSICAL THERAPY AND SPORTS
Active
Organization
ELITE PHYSICAL THERAPY AND SPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK STACK PT (OWNER-MANAGER)
(808) 572-7790
Entity
Organization
Contact information
Practice address
1043 MAKAWAO AVE, SUITE 107, MAKAWAO, HI 96768-9465
(808) 572-7790
(808) 573-4721
Mailing address
1043 MAKAWAO AVE, SUITE 107, MAKAWAO, HI 96768-9465
(808) 572-7790
(808) 573-4721
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
W6201699001
HI
Other
Enumeration date
05/16/2006
Last updated
08/22/2020
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