Provider Demographics
NPI:1093694317
Name:IMADA, RATTIKORN (LMT)
Entity type:Individual
Prefix:
First Name:RATTIKORN
Middle Name:
Last Name:IMADA
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 1:1015 NOBLE LN
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2830
Mailing Address - Country:US
Mailing Address - Phone:808-294-0897
Mailing Address - Fax:
Practice Address - Street 1:1357 KAPIOLANI BLVD STE 800
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4536
Practice Address - Country:US
Practice Address - Phone:808-523-9043
Practice Address - Fax:808-526-0268
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-18109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist