Provider Demographics
NPI:1508657925
Name:BRINKWORTH, AVERY (LMT)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:BRINKWORTH
Suffix:
Gender:F
Credentials:LMT
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 57
Mailing Address - Street 2:
Mailing Address - City:HANALEI
Mailing Address - State:HI
Mailing Address - Zip Code:96714-0057
Mailing Address - Country:US
Mailing Address - Phone:760-994-9239
Mailing Address - Fax:
Practice Address - Street 1:4569 KUKUI ST
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1775
Practice Address - Country:US
Practice Address - Phone:808-664-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist