Provider Demographics
NPI:1982032504
Name:HUBBELL, KERRY (LMT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:HUBBELL
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 1:15-902 PUNAWAI ST
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-9664
Mailing Address - Country:US
Mailing Address - Phone:206-902-6159
Mailing Address - Fax:
Practice Address - Street 1:15-902 PUNAWAI ST
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-9664
Practice Address - Country:US
Practice Address - Phone:206-902-6159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13385225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist