Individual
SUSANNE MACKINNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
42 BALDWIN AVE, PAIA, HI 96779
(808) 579-6070
Mailing address
PO BOX 790569, PAIA, HI 96779-0569
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT#4625
HI
Other
Enumeration date
10/19/2007
Last updated
10/19/2007
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