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General NPI Number Information
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NPI Number | 1275156069
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Entity Type | Organization
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Legal Business Name | BODY NATURE PHYSICAL THERAPY , LLC
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 10/16/2020
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Provider Practice Location Address
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Address Line | 153 E KAMEHAMEHA AVE STE 104
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City | KAHULUI
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State | HI
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Zip | 96732-3424
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Country | US
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Telephone | 808-856-9890
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Fax | 808-427-4202
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Provider Business Mailing Address
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Address Line | PO BOX 472
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City | MAKAWAO
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State | HI
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Zip | 96768-0472
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Country | US
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Telephone | 808-856-9890
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Fax | 808-427-4202
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Authorized Official
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Title or Position | OWNER
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Name | JUYHUN KIM
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Credential | RPT
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Telephone | 808-856-9890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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