Provider Demographics
NPI:1144903329
Name:TERUYA, ELIZABETH A (LMTQ)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:TERUYA
Suffix:
Gender:F
Credentials:LMTQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 MOTT-SMITH DR APT 2409
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2840
Mailing Address - Country:US
Mailing Address - Phone:808-741-6364
Mailing Address - Fax:
Practice Address - Street 1:600 QUEEN ST STE C2
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5113
Practice Address - Country:US
Practice Address - Phone:808-745-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15645225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty