Provider Demographics
NPI:1396943536
Name:SUTTON, TERRA K (LMT LICENSED MASSAGE)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:K
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LMT LICENSED MASSAGE
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 1080
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-1080
Mailing Address - Country:US
Mailing Address - Phone:808-889-1010
Mailing Address - Fax:800-378-0367
Practice Address - Street 1:54-3877 AKONI PULE HWY
Practice Address - Street 2:SUITE # 4
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:808-889-1010
Practice Address - Fax:800-378-0367
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT5649225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist