Provider Demographics
NPI:1114469889
Name:WERNEKE, KATHRYN T (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:T
Last Name:WERNEKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1265 LUMIKULA ST # 1B
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4088
Mailing Address - Country:US
Mailing Address - Phone:732-597-4589
Mailing Address - Fax:
Practice Address - Street 1:94-408 AKOKI ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2733
Practice Address - Country:US
Practice Address - Phone:808-676-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI834252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI646440001Medicaid