Provider Demographics
NPI:1639413909
Name:LOPEZ, LINDA A (LMT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2395 S KIHEI RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8635
Mailing Address - Country:US
Mailing Address - Phone:808-875-4357
Mailing Address - Fax:808-333-3693
Practice Address - Street 1:2395 S KIHEI RD
Practice Address - Street 2:SUITE 202
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8635
Practice Address - Country:US
Practice Address - Phone:808-875-4357
Practice Address - Fax:808-333-3693
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1111225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist