Provider Demographics
NPI:1760805857
Name:SITTS, MARK (LMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SITTS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOBRON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2103
Mailing Address - Country:US
Mailing Address - Phone:808-269-1884
Mailing Address - Fax:
Practice Address - Street 1:16 HOBRON AVE STE 204
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2103
Practice Address - Country:US
Practice Address - Phone:808-269-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-9156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist