Individual
ILLAH FOLSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5281 LOWER KULA RD, KULA, HI 96790-7712
(808) 269-2972
(808) 878-1879
Mailing address
PO BOX 361, KULA, HI 96790-0361
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT-15920
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAT-15920
MASSAGE LICENSE
HI
Enumeration date
03/14/2019
Last updated
03/14/2019
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