# PROFESSIONAL REHAB THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669612941
- **Authorized official:** MS. KATHLEEN I. CLARK (OWNER/THERAPIST)
- **Authorized official phone:** (808) 671-7414

## Contact information

- **Practice address:** 94-229 WAIPAHU DEPOT ST STE 301, WAIPAHU, HI 96797-3033
- **Practice address phone:** (808) 671-7414
- **Practice address fax:** (808) 671-7133
- **Mailing address:** 94-229 WAIPAHU DEPOT ST STE 301, WAIPAHU, HI 96797-3033
- **Mailing address phone:** (808) 671-7414
- **Mailing address fax:** (808) 671-7133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | HI | Yes |
| 225700000X | Massage Therapist | MAT 8855 | HI | — |

## Other

- **Enumeration date:** 02/27/2009
- **Last updated:** 02/27/2009