Healthcare Provider Details

I. General information

NPI: 1760200604
Provider Name (Legal Business Name): SARAH A TIBI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-901 KUHIO HWY STE B
KAPAA HI
96746-1549
US

IV. Provider business mailing address

4-901 KUHIO HWY STE B
KAPAA HI
96746-1549
US

V. Phone/Fax

Practice location:
  • Phone: 808-826-6000
  • Fax: 844-965-9830
Mailing address:
  • Phone: 808-826-6000
  • Fax: 844-965-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-17579
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: