Healthcare Provider Details

I. General information

NPI: 1750114674
Provider Name (Legal Business Name): KRISTEN BURKHART LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 BANYAN DR # 115
HILO HI
96720-4693
US

IV. Provider business mailing address

PO BOX 379
PAPAIKOU HI
96781-0379
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-1044
  • Fax:
Mailing address:
  • Phone: 650-492-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-17383
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: