Provider Demographics
NPI:1225879687
Name:MOORHOUSE, VICTORIA (LMT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MOORHOUSE
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:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-0122
Mailing Address - Country:US
Mailing Address - Phone:808-220-4062
Mailing Address - Fax:
Practice Address - Street 1:71 BANYAN DR
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4693
Practice Address - Country:US
Practice Address - Phone:808-969-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT15174225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist