Provider Demographics
NPI:1235813585
Name:THERING, GLENN
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:THERING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GLENN
Other - Middle Name:
Other - Last Name:THERING, LMT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:PO BOX 235578
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 KAPIOLANI BLVD STE 6A3
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3513
Practice Address - Country:US
Practice Address - Phone:808-382-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT2925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist