Provider Demographics
NPI:1235813254
Name:BODYWISE LLC
Entity Type:Organization
Organization Name:BODYWISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGOIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-269-7935
Mailing Address - Street 1:540 W KUIAHA RD
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5623
Mailing Address - Country:US
Mailing Address - Phone:808-269-7935
Mailing Address - Fax:
Practice Address - Street 1:540 W KUIAHA RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5623
Practice Address - Country:US
Practice Address - Phone:808-269-7935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy