Provider Demographics
NPI:1174836605
Name:GALENA, MATTHEW CHARLES (MT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHARLES
Last Name:GALENA
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:CHARLES
Other - Last Name:FRATUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:1215 S KIHEI RD STE O-610
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5220
Mailing Address - Country:US
Mailing Address - Phone:808-463-7734
Mailing Address - Fax:
Practice Address - Street 1:480 KENOLIO RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7500
Practice Address - Country:US
Practice Address - Phone:808-463-7734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist