Provider Demographics
NPI:1083979272
Name:MARIANO, GRACE (LMT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MARIANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-720 LANIKUHANA AVE
Mailing Address - Street 2:140
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2985
Mailing Address - Country:US
Mailing Address - Phone:808-623-6244
Mailing Address - Fax:808-623-6414
Practice Address - Street 1:95-720 LANIKUHANA AVE
Practice Address - Street 2:140
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2985
Practice Address - Country:US
Practice Address - Phone:808-623-6244
Practice Address - Fax:808-623-6414
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMT 6766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist