Provider Demographics
NPI:1801769658
Name:ALLISON, KEITH KINCADE (LMT)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:KINCADE
Last Name:ALLISON
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 1:2318 LIME ST APT 204
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4209
Mailing Address - Country:US
Mailing Address - Phone:253-886-1232
Mailing Address - Fax:
Practice Address - Street 1:500 ALA MOANA BLVD STE 6D
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4984
Practice Address - Country:US
Practice Address - Phone:253-886-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-18182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty