Provider Demographics
NPI:1821373515
Name:MOLITAS, SAMMY DARYL (LMT)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:DARYL
Last Name:MOLITAS
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 1:44 KANANI RD APT 1-106
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6714
Mailing Address - Country:US
Mailing Address - Phone:808-854-7243
Mailing Address - Fax:
Practice Address - Street 1:1993 S KIHEI RD STE 16
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7821
Practice Address - Country:US
Practice Address - Phone:808-854-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 11408225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist