Organization
HAWAI'I SPORTS PERFORMANCE AND REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENELLE BOTJE DPT (DOCTOR OF PHYSICAL THERAPY)
(304) 942-1726
Entity
Organization
Contact information
Practice address
75-5660 KOPIKO ST, KAILUA KONA, HI 96740-3611
(304) 942-1726
Mailing address
76-6167 ALII DR, KAILUA KONA, HI 96740-2387
(304) 942-1726
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12669923
CAQH
HI
Enumeration date
10/15/2018
Last updated
10/15/2018
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