Provider Demographics
NPI:1649721770
Name:COLLINS, SUSAN C (LMT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:COLLINS
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 1:153 E KAMEHAMEHA AVE STE 104-250
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3424
Mailing Address - Country:US
Mailing Address - Phone:808-269-0133
Mailing Address - Fax:
Practice Address - Street 1:360 HOOHANA ST STE A104
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2975
Practice Address - Country:US
Practice Address - Phone:808-877-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT1483171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI225700000XOtherMASSAGE THERAPY