Provider Demographics
NPI:1083004865
Name:NAVARRO, TERESA (MT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5706 KUAKINI HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1751
Mailing Address - Country:US
Mailing Address - Phone:808-345-7542
Mailing Address - Fax:
Practice Address - Street 1:75-5706 KUAKINI HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1751
Practice Address - Country:US
Practice Address - Phone:808-345-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 12604225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist