Provider Demographics
NPI:1770014680
Name:MIYAGI, CAROLYN (LMP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:MIYAGI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HAMAKUA DR STE B
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2849
Mailing Address - Country:US
Mailing Address - Phone:808-261-0301
Mailing Address - Fax:808-261-8931
Practice Address - Street 1:155 HAMAKUA DR STE B
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2849
Practice Address - Country:US
Practice Address - Phone:808-261-0301
Practice Address - Fax:808-261-8931
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4705225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist