Provider Demographics
NPI:1417258419
Name:REILLY, CECILIA ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ROSE
Last Name:REILLY
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 1:618 HANA HWY
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-9733
Mailing Address - Country:US
Mailing Address - Phone:808-214-7459
Mailing Address - Fax:
Practice Address - Street 1:108 KANANI RD
Practice Address - Street 2:APT. #401A
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8791
Practice Address - Country:US
Practice Address - Phone:808-214-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-5317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist