Individual
TIMOTHY SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
75-5995 KUAKINI HWY STE 603A, KAILUA KONA, HI 96740-2124
(808) 313-1927
Mailing address
PO BOX 1240, KEALAKEKUA, HI 96750-1240
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT16589
HI
Other
Enumeration date
05/23/2021
Last updated
05/23/2021
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