Organization
BETTY FACKLER DBA SOUTH KONA PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MENDY LACEY (BILLING MANANGER)
(808) 322-6149
Entity
Organization
Contact information
Practice address
82-6066 MAMALAHOA HWY, 7, CAPTAIN COOK, HI 96704-8204
(808) 323-8123
(808) 323-8125
Mailing address
82-6066 MAMALAHOA HWY, 7, CAPTAIN COOK, HI 96704-8204
(808) 323-8123
(808) 323-8125
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT-1737
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57447703
—
HI
Enumeration date
08/30/2016
Last updated
08/30/2016
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