Provider Demographics
NPI:1073352498
Name:BRUESCH, CAROLINE MIRA (LMT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MIRA
Last Name:BRUESCH
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 1:75-5259 MAMALAHOA HWY APT F
Mailing Address - Street 2:
Mailing Address - City:HOLUALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96725-9643
Mailing Address - Country:US
Mailing Address - Phone:808-345-7580
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:808-680-9123
Practice Address - Fax:808-680-9889
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-16250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist