Provider Demographics
NPI:1679070403
Name:RAUTMANN, TYLER YAMAUCHI (MAT-14666)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:YAMAUCHI
Last Name:RAUTMANN
Suffix:
Gender:M
Credentials:MAT-14666
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-0718
Mailing Address - Country:US
Mailing Address - Phone:808-652-0563
Mailing Address - Fax:
Practice Address - Street 1:7729 KOOLAU RD
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754
Practice Address - Country:US
Practice Address - Phone:808-652-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14666225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist