Healthcare Provider Details

I. General information

NPI: 1093639064
Provider Name (Legal Business Name): TANYA C ROBERTS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-2891 PAHOA VILLAGE RD
PAHOA HI
96778-9775
US

IV. Provider business mailing address

PO BOX 1964
PAHOA HI
96778-1964
US

V. Phone/Fax

Practice location:
  • Phone: 401-871-2179
  • Fax:
Mailing address:
  • Phone: 401-871-2179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7357
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: