Provider Demographics
NPI:1487071643
Name:MATSUO, CHRISTOPHER LEE (LMT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:MATSUO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 KAMANI STREET
Mailing Address - Street 2:DRAGON GATE SANCTUARY (HERBOLOGIE BLDG)
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5313
Mailing Address - Country:US
Mailing Address - Phone:808-286-1823
Mailing Address - Fax:
Practice Address - Street 1:318 KAMANI STREET
Practice Address - Street 2:DRAGON GATE SANCTUARY (HERBOLOGIE BLDG)
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-286-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT12776225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist