Provider Demographics
NPI:1144518846
Name:MID PACIFIC MASSAGE THERAPY, LLC
Entity type:Organization
Organization Name:MID PACIFIC MASSAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST - OWNER/ FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MUELANG
Authorized Official - Middle Name:KAULANA
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MAT
Authorized Official - Phone:808-268-2684
Mailing Address - Street 1:PO BOX 1906
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-1906
Mailing Address - Country:US
Mailing Address - Phone:808-268-2684
Mailing Address - Fax:866-799-4374
Practice Address - Street 1:221 PIIKEA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8268
Practice Address - Country:US
Practice Address - Phone:808-268-2684
Practice Address - Fax:866-799-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11826225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty