Provider Demographics
NPI:1194179465
Name:STEPHENSON, ERIC (LMT, RMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:LMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 MAKAWAO AVE
Mailing Address - Street 2:SUITE 101, WHOLE BODY WELLNESS
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7403
Mailing Address - Country:US
Mailing Address - Phone:808-280-4327
Mailing Address - Fax:
Practice Address - Street 1:1135 MAKAWAO AVE
Practice Address - Street 2:SUITE 101, WHOLE BODY WELLNESS
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7403
Practice Address - Country:US
Practice Address - Phone:808-280-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT14446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist