Provider Demographics
NPI:1720207657
Name:REDFORD, DOREEN GRAY (LMT)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:GRAY
Last Name:REDFORD
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 1:98-288 KAONOHI ST
Mailing Address - Street 2:#3004
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-2366
Mailing Address - Country:US
Mailing Address - Phone:808-366-5007
Mailing Address - Fax:808-487-7854
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:813
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-955-7246
Practice Address - Fax:808-955-7249
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist