Provider Demographics
NPI:1336563436
Name:STEPHANIE BATH, LICENSED MASSAGE THERAPIST
Entity Type:Organization
Organization Name:STEPHANIE BATH, LICENSED MASSAGE THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-933-1131
Mailing Address - Street 1:41 LAIMANA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2542
Mailing Address - Country:US
Mailing Address - Phone:808-933-1131
Mailing Address - Fax:808-935-3900
Practice Address - Street 1:41 LAIMANA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2542
Practice Address - Country:US
Practice Address - Phone:808-933-1131
Practice Address - Fax:808-935-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-1253225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty