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General NPI Number Information
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NPI Number | 1386856763
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Entity Type | Individual
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Provider Name | ERIC ANDREW MATHIS LMT
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Gender | Male
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1834 NUUANU AVE SUITE 201
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City | HONOLULU
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State | HI
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Zip | 96817-2427
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Country | US
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Telephone | 808-292-8417
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Fax |
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Provider Business Mailing Address
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Address Line | 801 S KING ST #1604
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City | HONOLULU
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State | HI
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Zip | 96813-3008
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Country | US
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Telephone | 808-292-8417
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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 | MAT 9956
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License Number State | HI
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