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General NPI Number Information
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NPI Number | 1508657925
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Entity Type | Individual
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Provider Name | AVERY BRINKWORTH LMT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 4569 KUKUI ST
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City | KAPAA
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State | HI
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Zip | 96746-1775
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Country | US
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Telephone | 808-664-6040
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | HANALEI
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State | HI
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Zip | 96714-0057
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Country | US
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Telephone | 760-994-9239
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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 | 17596
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License Number State | HI
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