Provider Demographics
NPI:1962687558
Name:CARY, BRUCE M (LMT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:CARY
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 1:377 IHE PLACE
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8907
Mailing Address - Country:US
Mailing Address - Phone:808-244-4600
Mailing Address - Fax:
Practice Address - Street 1:1959 B KAOHU STREET
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2311
Practice Address - Country:US
Practice Address - Phone:808-244-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT1806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist