Healthcare Provider Details

I. General information

NPI: 1205759453
Provider Name (Legal Business Name): DETOX MASSAGE & STRETCH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-029 HEKAHA ST STE 40
AIEA HI
96701-4918
US

IV. Provider business mailing address

1822 KAUMUALII ST
HONOLULU HI
96819-4042
US

V. Phone/Fax

Practice location:
  • Phone: 808-590-4401
  • Fax:
Mailing address:
  • Phone: 808-590-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODI SYLVA
Title or Position: OWNER/MEM
Credential: LMT
Phone: 808-707-9177