Provider Demographics
NPI:1225233927
Name:DAGLEY, ROSS M (NMT)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:M
Last Name:DAGLEY
Suffix:
Gender:M
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 ALA OLU PL
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5077
Mailing Address - Country:US
Mailing Address - Phone:808-264-1581
Mailing Address - Fax:
Practice Address - Street 1:1958 E VINEYARD ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1715
Practice Address - Country:US
Practice Address - Phone:808-344-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist