Provider Demographics
NPI:1255618948
Name:HAYNES, RENE (MAT)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:HAYNES
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:PO BOX 1608
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96733-1608
Mailing Address - Country:US
Mailing Address - Phone:808-871-4645
Mailing Address - Fax:808-873-8383
Practice Address - Street 1:53 N PUUNENE AVE
Practice Address - Street 2:104 C
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:US
Practice Address - Phone:808-871-4645
Practice Address - Fax:808-873-8383
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 2287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist