Provider Demographics
NPI:1245749308
Name:KAPOLEI MASSAGE INSTITUTE LLC
Entity Type:Organization
Organization Name:KAPOLEI MASSAGE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:CARRAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-228-9830
Mailing Address - Street 1:2176 LAUWILIWILI ST STE 1
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1882
Mailing Address - Country:US
Mailing Address - Phone:808-228-9830
Mailing Address - Fax:
Practice Address - Street 1:2176 LAUWILIWILI ST STE 1
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1882
Practice Address - Country:US
Practice Address - Phone:808-228-9830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMA3146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty