Healthcare Provider Details

I. General information

NPI: 1104739804
Provider Name (Legal Business Name): CRYSTAL MARIE BARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N HOLOPONO ST # C-111
KIHEI HI
96753-6945
US

IV. Provider business mailing address

150 KEALA PL
KIHEI HI
96753-7833
US

V. Phone/Fax

Practice location:
  • Phone: 808-276-7278
  • Fax:
Mailing address:
  • Phone: 808-276-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT11938
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: