Provider Demographics
NPI:1669805651
Name:DEGREGORIO, CORY (LMT)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:DEGREGORIO
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 1:92-1329 PRINCE KUHIO BLVD STE 4 PMB 472
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704
Mailing Address - Country:US
Mailing Address - Phone:808-765-7200
Mailing Address - Fax:
Practice Address - Street 1:92-1329 PRINCE KUHIO BLVD STE 4 PMB 472
Practice Address - Street 2:
Practice Address - City:CAPTAIN COOK
Practice Address - State:HI
Practice Address - Zip Code:96704
Practice Address - Country:US
Practice Address - Phone:808-765-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-17674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist