Healthcare Provider Details

I. General information

NPI: 1063173227
Provider Name (Legal Business Name): KODY JOHN SEMINARA DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-849 LUMIAINA ST UNIT 101
WAIPAHU HI
96797-5677
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 550
HONOLULU HI
96814-1880
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-8947
  • Fax: 800-586-4356
Mailing address:
  • Phone: 808-381-8947
  • Fax: 800-586-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-611
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-6042
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: