Provider Demographics
NPI:1376374546
Name:KNEAD PROFESSIONAL MASSAGE LLC
Entity type:Organization
Organization Name:KNEAD PROFESSIONAL MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAZELYN
Authorized Official - Middle Name:UY
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:LMT/MMP
Authorized Official - Phone:808-391-8288
Mailing Address - Street 1:94-916 WAIPAHU ST STE B
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-6303
Mailing Address - Country:US
Mailing Address - Phone:808-688-1808
Mailing Address - Fax:
Practice Address - Street 1:94-916 WAIPAHU ST STE B
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6303
Practice Address - Country:US
Practice Address - Phone:808-688-1808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty