Provider Demographics
NPI:1124470810
Name:COURTNEY-ARCIAGA, TAMMY L (LMT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:COURTNEY-ARCIAGA
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 1:338 KAMOKILA BLVD
Mailing Address - Street 2:#201
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2055
Mailing Address - Country:US
Mailing Address - Phone:808-674-9998
Mailing Address - Fax:808-674-9877
Practice Address - Street 1:338 KAMOKILA BLVD
Practice Address - Street 2:#201
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2055
Practice Address - Country:US
Practice Address - Phone:808-674-9998
Practice Address - Fax:808-674-9877
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 6553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist