Provider Demographics
NPI:1689037079
Name:LARAMIE, ANDREA (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:LARAMIE
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 1:1760 HONOAPIILANI HWY UNIT 13017
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-5121
Mailing Address - Country:US
Mailing Address - Phone:808-268-2779
Mailing Address - Fax:
Practice Address - Street 1:845 WAINEE ST
Practice Address - Street 2:SUITE 211
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2321
Practice Address - Country:US
Practice Address - Phone:808-667-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11756225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist