Provider Demographics
NPI:1508115486
Name:AQUINO, MICHAEL C (LMT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:AQUINO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 ALA ALII STREET
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818
Mailing Address - Country:US
Mailing Address - Phone:808-227-4647
Mailing Address - Fax:
Practice Address - Street 1:627 SOUTH ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5050
Practice Address - Country:US
Practice Address - Phone:808-227-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT - 12210225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist