Provider Demographics
NPI:1932716719
Name:MIZUUCHI, GARY (LMT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MIZUUCHI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 S KING ST APT E
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2330
Mailing Address - Country:US
Mailing Address - Phone:808-221-2766
Mailing Address - Fax:
Practice Address - Street 1:600 KAPIOLANI BLVD STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5139
Practice Address - Country:US
Practice Address - Phone:808-368-1898
Practice Address - Fax:808-744-9291
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist