Provider Demographics
NPI:1376611707
Name:YOUNG, ROXANNE REIKO LA'AKEA (LMT, BCTMB, MBA)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:REIKO LA'AKEA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMT, BCTMB, MBA
Other - Prefix:MS
Other - First Name:ROXANNE
Other - Middle Name:RLY
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, BCTMB, MBA, CPT
Mailing Address - Street 1:PO BOX 23174
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3174
Mailing Address - Country:US
Mailing Address - Phone:808-630-6552
Mailing Address - Fax:
Practice Address - Street 1:1122 WILDER AVE APT 105
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2751
Practice Address - Country:US
Practice Address - Phone:808-630-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
HIMAT 8096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty