Provider Demographics
NPI:1205165040
Name:ROSA, LEOLANI (MAT)
Entity type:Individual
Prefix:MS
First Name:LEOLANI
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 KANEKA ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-8005
Mailing Address - Country:US
Mailing Address - Phone:808-652-4946
Mailing Address - Fax:
Practice Address - Street 1:2130 KANEKA ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-8005
Practice Address - Country:US
Practice Address - Phone:808-652-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT8102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist