Provider Demographics
NPI:1881969715
Name:BRITT, TERESA (LMT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BRITT
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 1:1450 S KIHEI RD
Mailing Address - Street 2:APT. D-108
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8154
Mailing Address - Country:US
Mailing Address - Phone:808-214-7012
Mailing Address - Fax:
Practice Address - Street 1:2679 WAI WAI PL
Practice Address - Street 2:SUITE 204
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8196
Practice Address - Country:US
Practice Address - Phone:808-214-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-10
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12362171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI12362OtherMASSAGE LICENSE