Healthcare Provider Details

I. General information

NPI: 1912177957
Provider Name (Legal Business Name): LYONSMASSAGE&BODYWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 NAHUA ST
HONOLULU HI
96815-2949
US

IV. Provider business mailing address

427 NAHUA ST
HONOLULU HI
96815-2949
US

V. Phone/Fax

Practice location:
  • Phone: 808-924-7845
  • Fax:
Mailing address:
  • Phone: 808-924-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMAT8565
License Number StateHI

VIII. Authorized Official

Name: MR. REID KEN LYONS
Title or Position: PRESIDENT
Credential: LMT
Phone: 808-924-7845