# KAILUA PHYSICAL THERAPY CLINIC, INC

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

## Provider details

- **NPI number:** 1992031330
- **Authorized official:** MS. MARYANN GIANANTONI LPT (PHYSICIAL THERAPIST)
- **Authorized official phone:** (808) 261-8931

## Contact information

- **Practice address:** 155 HAMAKUA DR STE B, KAILUA, HI 96734-2849
- **Practice address phone:** (808) 261-8931
- **Practice address fax:** (808) 261-0301
- **Mailing address:** 155 HAMAKUA DR STE B, KAILUA, HI 96734-2849
- **Mailing address phone:** (808) 261-8931
- **Mailing address fax:** (808) 261-0301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 707 | HI | Yes |

## Other

- **Enumeration date:** 10/20/2009
- **Last updated:** 10/20/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6955 | MASSAGE THERAPIST | HI |
| 01 | — | 707 | STATE OF HAWAII PHYSICAL THERAPIST LICENSE | HI |