Healthcare Provider Details

I. General information

NPI: 1770926271
Provider Name (Legal Business Name): KEVIN JUDE BENDER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 WELLS ST STE 2
WAILUKU HI
96793-2370
US

IV. Provider business mailing address

411 HUKU LII PL STE 101
KIHEI HI
96753-7062
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-0077
  • Fax:
Mailing address:
  • Phone: 808-879-0077
  • Fax: 808-879-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28105
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5017
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: