Provider Demographics
NPI:1366687618
Name:PACIFIC, DANIELLE M (LMT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:PACIFIC
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 1:17-249 MEAULU ST
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8206
Mailing Address - Country:US
Mailing Address - Phone:808-276-0608
Mailing Address - Fax:
Practice Address - Street 1:17-249 MEAULU ST
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8206
Practice Address - Country:US
Practice Address - Phone:808-276-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.008514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist