Healthcare Provider Details

I. General information

NPI: 1336563436
Provider Name (Legal Business Name): STEPHANIE BATH, LICENSED MASSAGE THERAPIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 LAIMANA ST
HILO HI
96720-2542
US

IV. Provider business mailing address

41 LAIMANA ST
HILO HI
96720-2542
US

V. Phone/Fax

Practice location:
  • Phone: 808-933-1131
  • Fax: 808-935-3900
Mailing address:
  • Phone: 808-933-1131
  • Fax: 808-935-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-1253
License Number StateHI

VIII. Authorized Official

Name: MRS. STEPHANIE BATH
Title or Position: OWNER
Credential: L..M.T.
Phone: 808-933-1131