Provider Demographics
NPI:1568161222
Name:EWE, KEANA K (LMT)
Entity Type:Individual
Prefix:
First Name:KEANA
Middle Name:K
Last Name:EWE
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 1:1442 AHEAHE AVE
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1208
Mailing Address - Country:US
Mailing Address - Phone:808-551-1103
Mailing Address - Fax:
Practice Address - Street 1:95 S KAM HWY
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1873
Practice Address - Country:US
Practice Address - Phone:808-425-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14558225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist