MEDICARE: MRS. HIROMI LANE MAT-12285

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MAT-12285	HI

General Provider Information

NPI Number	:	1225501125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HIROMI LANE MAT-12285

Provider Business Mailing Address
First Line	:	1833 KALAKAUA AVE STE 1011
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96815-1528
Country	:	US
Telephone Number	:	808-291-0170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 KALAKAUA AVE STE 1011
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96815-1528
Country	:	US
Telephone Number	:	808-291-0170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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