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General NPI Number Information
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NPI Number | 1235397589
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Entity Type | Organization
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Legal Business Name | BODYPRO PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 65-1292 KAWAIHAE RD STE A
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City | KAMUELA
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State | HI
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Zip | 96743-8404
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Country | US
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Telephone | 808-494-0197
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Fax | 808-887-1373
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Provider Business Mailing Address
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Address Line | PO BOX 6810
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City | KAMUELA
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State | HI
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Zip | 96743-6810
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Country | US
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Telephone | 808-887-1371
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Fax | 808-887-1373
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN ALLEN WARNEKE
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Credential | PT
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Telephone | 808-887-1371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2646
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License Number State | HI
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