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General NPI Number Information
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NPI Number | 1689166217
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Entity Type | Individual
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Provider Name | CRISTIN A ERTEL LMT
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Gender | Female
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 354 ULUNIU ST STE 104
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City | KAILUA
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State | HI
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Zip | 96734-2532
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Country | US
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Telephone | 412-478-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 230 ILIKEA PL
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City | KAILUA
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State | HI
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Zip | 96734-2358
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Country | US
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Telephone | 412-478-5300
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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 | 12053
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License Number State | HI
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