Provider Demographics
NPI:1346557972
Name:CARROLL, RUTH (MAT)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 HAWAII KAI DR
Mailing Address - Street 2:116
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3184
Mailing Address - Country:US
Mailing Address - Phone:808-497-4987
Mailing Address - Fax:
Practice Address - Street 1:233 HALEMAUMAU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2055
Practice Address - Country:US
Practice Address - Phone:808-497-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-2410225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist