Provider Demographics
NPI:1053484311
Name:MOLS, DAVID JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH
Last Name:MOLS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 128 AIEA HTS DR
Mailing Address - Street 2:SU 701
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:808-488-5665
Mailing Address - Fax:808-486-6090
Practice Address - Street 1:99 128 AIEA HTS DR
Practice Address - Street 2:SU 701
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701
Practice Address - Country:US
Practice Address - Phone:808-488-5665
Practice Address - Fax:808-486-6090
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
192595101OtherHMA
HI52349001Medicaid
HI52349001Medicaid
192595101OtherHMA