Provider Demographics
NPI:1629568266
Name:CALLAWAY, BRIA LANI (LMT)
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:LANI
Last Name:CALLAWAY
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 1:1437 KILAUEA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4200
Mailing Address - Country:US
Mailing Address - Phone:808-345-9106
Mailing Address - Fax:
Practice Address - Street 1:1437 KILAUEA AVE STE 103
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4200
Practice Address - Country:US
Practice Address - Phone:808-345-9106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI$$$$$$$$$OtherMASSAGE