Provider Demographics
NPI:1699384701
Name:COVEY, LAURA (LMT MMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COVEY
Suffix:
Gender:F
Credentials:LMT MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 ALAHEE DR APT B
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1202
Mailing Address - Country:US
Mailing Address - Phone:808-269-3404
Mailing Address - Fax:
Practice Address - Street 1:WAILUKU COMMUNITY ACUPUNCTURE
Practice Address - Street 2:33 CENTRAL AVE
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-269-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT14873225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist