Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 9095 | HI |
NPI | 1013247600 |
---|---|
Provider Name | Heidi Byron |
First Address | Hilo, HI 96721-5821 |
Second Address | Hilo, HI 96720-2943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2010 |
Last Update Date | 05/01/2010 |