Provider Demographics
NPI:1790140705
Name:MASSAGE THERAPY
Entity Type:Organization
Organization Name:MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SRI MARLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMINOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-268-8852
Mailing Address - Street 1:PO BOX 532524
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-2524
Mailing Address - Country:US
Mailing Address - Phone:180-826-8885
Mailing Address - Fax:
Practice Address - Street 1:2045 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1648
Practice Address - Country:US
Practice Address - Phone:180-924-2884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty