=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316702699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPEUTIC MASSAGE AND SPA BY 'D' HEART LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2024
-----------------------------------------------------
Last Update Date | 02/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 668 CALIFORNIA AVE
-----------------------------------------------------
City | WAHIAWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96786-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-699-1017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 668 CALIFORNIA AVE
-----------------------------------------------------
City | WAHIAWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96786-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-699-1017
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPIST/OWNER
-----------------------------------------------------
Name | MRS. CARRIE ANN TYCHUAN PAZ
-----------------------------------------------------
Credential | MAT
-----------------------------------------------------
Telephone | 808-798-5845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------