Provider Demographics
NPI:1275156069
Name:BODY NATURE PHYSICAL THERAPY , LLC
Entity Type:Organization
Organization Name:BODY NATURE PHYSICAL THERAPY , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUYHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:808-856-9890
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0472
Mailing Address - Country:US
Mailing Address - Phone:808-856-9890
Mailing Address - Fax:808-427-4202
Practice Address - Street 1:153 E KAMEHAMEHA AVE STE 104
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3424
Practice Address - Country:US
Practice Address - Phone:808-856-9890
Practice Address - Fax:808-427-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy