Provider Demographics
NPI:1770721623
Name:GARRETT, GLORIA JEAN (LMT)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:GARRETT
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 1:30 LAUMAKANI LOOP
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8200
Mailing Address - Country:US
Mailing Address - Phone:808-879-1186
Mailing Address - Fax:808-879-1186
Practice Address - Street 1:30 LAUMAKANI LOOP
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8200
Practice Address - Country:US
Practice Address - Phone:808-879-1186
Practice Address - Fax:808-879-1186
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 4221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist