Provider Demographics
NPI:1083238240
Name:TENISHA RUIDAS LLC
Entity Type:Organization
Organization Name:TENISHA RUIDAS LLC
Other - Org Name:BODY BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENISHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-633-6167
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-0309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99-1255 WAIUA PL UNIT E
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5620
Practice Address - Country:US
Practice Address - Phone:808-633-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI15385OtherLICENSED MASSAGE THERAPIST