Organization
TEAM PHYSICAL THERAPY LLC
Active
Other names
Enchanted Lake Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD K. A. CLARK MSPT (CO-OWNER/PHYSICAL THERAPIST)
(808) 262-2292
Entity
Organization
Contact information
Practice address
1090 KEOLU DR, SUITE 104, KAILUA, HI 96734-3871
(808) 262-2292
Mailing address
PO BOX 1440, KAILUA, HI 96734-1440
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/13/2011
Last updated
03/11/2016
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