Provider Demographics
NPI:1245062645
Name:WILLIAMS, TERRILL JAMES KANE ALII (LMT)
Entity type:Individual
Prefix:MR
First Name:TERRILL JAMES
Middle Name:KANE ALII
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 790172
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-0172
Mailing Address - Country:US
Mailing Address - Phone:808-517-5562
Mailing Address - Fax:
Practice Address - Street 1:74 KUNIHI LN APT 427
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1383
Practice Address - Country:US
Practice Address - Phone:808-517-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAT-17938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist