Provider Demographics
NPI:1811017528
Name:ROSE, CYNTHIA ELIZABETH (LMT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ELIZABETH
Last Name:ROSE
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:PO BOX 880534
Mailing Address - Street 2:
Mailing Address - City:PUKALANI
Mailing Address - State:HI
Mailing Address - Zip Code:96788-0534
Mailing Address - Country:US
Mailing Address - Phone:808-283-6806
Mailing Address - Fax:808-573-2624
Practice Address - Street 1:2785 AINA LANI DR
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8403
Practice Address - Country:US
Practice Address - Phone:808-283-6806
Practice Address - Fax:808-573-2621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 7397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist