Provider Demographics
NPI:1043532062
Name:ULIBAS, JONATHAN WAYNE (LMT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN WAYNE
Middle Name:
Last Name:ULIBAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BISHOP ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2819
Mailing Address - Country:US
Mailing Address - Phone:808-626-5964
Mailing Address - Fax:
Practice Address - Street 1:1111 BISHOP ST
Practice Address - Street 2:SUITE 508
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2819
Practice Address - Country:US
Practice Address - Phone:808-626-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 8966225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist