Individual
MARTIN SCOTT WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
68-3840 LUA KULA ST, ADMIN 3, WAIKOLOA, HI 96738
(808) 909-3111
Mailing address
68-3840 LUA KULA ST, ADMIN 3, WAIKOLOA, HI 96738
(808) 909-3111
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT-16955
HI
Other
Enumeration date
04/24/2024
Last updated
04/24/2024
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