Healthcare Provider Details

I. General information

NPI: 1932534252
Provider Name (Legal Business Name): ANN LEIALOHA ERBE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17-4590 OLD SOUTH ROAD
KURTISTOWN HI
96760
US

IV. Provider business mailing address

PO BOX 1105
KURTISTOWN HI
96760-1105
US

V. Phone/Fax

Practice location:
  • Phone: 808-258-8904
  • Fax:
Mailing address:
  • Phone: 808-258-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT 7311
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: