Provider Demographics
NPI:1538776737
Name:MAWAE, MISA (LMT)
Entity type:Individual
Prefix:
First Name:MISA
Middle Name:
Last Name:MAWAE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 KALAKAUA AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2440
Mailing Address - Country:US
Mailing Address - Phone:808-285-6423
Mailing Address - Fax:
Practice Address - Street 1:600 KAPIOLANI BLVD STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5139
Practice Address - Country:US
Practice Address - Phone:808-368-1898
Practice Address - Fax:808-744-9291
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-12316225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist