Provider Demographics
NPI:1679156053
Name:CARDWELL, MELISSA ROSE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ROSE
Last Name:CARDWELL
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 1:71 BANYAN DR STE 115
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4693
Mailing Address - Country:US
Mailing Address - Phone:808-640-4750
Mailing Address - Fax:
Practice Address - Street 1:71 BANYAN DR STE 115
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4693
Practice Address - Country:US
Practice Address - Phone:808-640-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist