Provider Demographics
NPI:1235397589
Name:BODYPRO PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:BODYPRO PHYSICAL THERAPY INC
Other - Org Name:BODYPRO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WARNEKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-887-1371
Mailing Address - Street 1:PO BOX 6810
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-6810
Mailing Address - Country:US
Mailing Address - Phone:808-887-1371
Mailing Address - Fax:808-887-1373
Practice Address - Street 1:65-1292 KAWAIHAE RD STE A
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8404
Practice Address - Country:US
Practice Address - Phone:808-494-0197
Practice Address - Fax:808-887-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT2646225100000X, 225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1235397589Medicaid
HI1235397589OtherHMSA