Provider Demographics
NPI:1316400161
Name:KUTTER, ELISE (LMT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:KUTTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 OKA ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5308
Mailing Address - Country:US
Mailing Address - Phone:808-828-2885
Mailing Address - Fax:808-828-0119
Practice Address - Street 1:2460 OKA ST STE 101A
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5308
Practice Address - Country:US
Practice Address - Phone:808-828-2885
Practice Address - Fax:808-828-0119
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-12042225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMAT-12042OtherDCCA LICENSING BOARD