Provider Demographics
NPI:1922057801
Name:KELLNER, BART M (PT, CMPT, CSCS)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:M
Last Name:KELLNER
Suffix:
Gender:M
Credentials:PT, CMPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 12TH AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3712
Mailing Address - Country:US
Mailing Address - Phone:808-734-4043
Mailing Address - Fax:808-737-7247
Practice Address - Street 1:1120 12TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3712
Practice Address - Country:US
Practice Address - Phone:808-734-4043
Practice Address - Fax:808-737-7247
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 1837208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSS#