Healthcare Provider Details

I. General information

NPI: 1154111680
Provider Name (Legal Business Name): ADRIAN THALASINOS HALEY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55-514 HAWI RD 88
KAPA'AU HI
96755
US

IV. Provider business mailing address

PO BOX 88
KAPAAU HI
96755-0088
US

V. Phone/Fax

Practice location:
  • Phone: 808-345-9486
  • Fax:
Mailing address:
  • Phone: 808-345-9486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-17881
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: