Provider Demographics
NPI:1356842918
Name:MAHELONA, BRYANN K (MT)
Entity Type:Individual
Prefix:
First Name:BRYANN
Middle Name:K
Last Name:MAHELONA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 KAMEHAMEHA HWY STE E
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3258
Mailing Address - Country:US
Mailing Address - Phone:808-780-3269
Mailing Address - Fax:
Practice Address - Street 1:379 KAMEHAMEHA HWY STE E
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3258
Practice Address - Country:US
Practice Address - Phone:808-780-3269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-13262225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist