Provider Demographics
NPI:1104566967
Name:SEARLES, DIANE VICKI (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:VICKI
Last Name:SEARLES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:HONOMU
Mailing Address - State:HI
Mailing Address - Zip Code:96728-0103
Mailing Address - Country:US
Mailing Address - Phone:808-769-0171
Mailing Address - Fax:
Practice Address - Street 1:465 HINANO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4406
Practice Address - Country:US
Practice Address - Phone:808-769-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist