Provider Demographics
NPI:1346874013
Name:HEAD, JOANN (LMT)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:95-720 LANIKUHANA AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2986
Mailing Address - Country:US
Mailing Address - Phone:808-623-6244
Mailing Address - Fax:
Practice Address - Street 1:95-720 LANIKUHANA AVE STE 140
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2986
Practice Address - Country:US
Practice Address - Phone:808-623-6244
Practice Address - Fax:808-623-6414
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist