Healthcare Provider Details

I. General information

NPI: 1821965161
Provider Name (Legal Business Name): ECCENTRIC THAI MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-3575 KAULUAKOKO ST UNIT 1403
EWA BEACH HI
96706-5859
US

IV. Provider business mailing address

91-3575 KAULUAKOKO ST UNIT 1403
EWA BEACH HI
96706-5859
US

V. Phone/Fax

Practice location:
  • Phone: 808-699-9971
  • Fax: 808-699-9971
Mailing address:
  • Phone: 808-699-9971
  • Fax: 808-699-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MATTHALIYA AMASULA
Title or Position: CEO
Credential: MAT-16658
Phone: 808-445-1768