Healthcare Provider Details

I. General information

NPI: 1225910581
Provider Name (Legal Business Name): 6TH AVENUE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PAGO PAGO ST.
PAGO PAGO AS
96799
US

IV. Provider business mailing address

PO BOX 122
PAGO PAGO AS
96799-0122
US

V. Phone/Fax

Practice location:
  • Phone: 808-425-6860
  • Fax:
Mailing address:
  • Phone: 808-425-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATASHA T LEDOUX-SONOMA
Title or Position: CEO
Credential:
Phone: 808-425-6860