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General NPI Number Information
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NPI Number | 1225879687
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Entity Type | Individual
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Provider Name | VICTORIA MOORHOUSE LMT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2024
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Last Update Date | 06/01/2024
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Provider Practice Location Address
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Address Line | 71 BANYAN DR
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City | HILO
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State | HI
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Zip | 96720-4693
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Country | US
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Telephone | 808-969-1044
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 122
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City | VOLCANO
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State | HI
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Zip | 96785-0122
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Country | US
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Telephone | 808-220-4062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAT15174
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License Number State | HI
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