Provider Demographics
NPI:1063173227
Name:SEMINARA, KODY JOHN (DPT, PT)
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:JOHN
Last Name:SEMINARA
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST STE 550
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1880
Mailing Address - Country:US
Mailing Address - Phone:808-381-8947
Mailing Address - Fax:800-586-4356
Practice Address - Street 1:94-849 LUMIAINA ST UNIT 101
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5677
Practice Address - Country:US
Practice Address - Phone:808-381-8947
Practice Address - Fax:800-586-4356
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPTA-611225200000X
HIPT-6042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty