Provider Demographics
NPI:1043628837
Name:HENRIQUES, SAMANTHA (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HENRIQUES
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 MALU RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1758
Mailing Address - Country:US
Mailing Address - Phone:808-821-4401
Mailing Address - Fax:
Practice Address - Street 1:4695 MAILIHUNA RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2051
Practice Address - Country:US
Practice Address - Phone:808-821-4401
Practice Address - Fax:808-821-4420
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT-572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer