Provider Demographics
NPI:1588406565
Name:FREEMAN, TOMOMI (MAT)
Entity type:Individual
Prefix:
First Name:TOMOMI
Middle Name:
Last Name:FREEMAN
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 1:975 ALA LILIKOI ST APT 902
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2415
Mailing Address - Country:US
Mailing Address - Phone:808-940-2022
Mailing Address - Fax:
Practice Address - Street 1:4510 SALT LAKE BLVD STE B6
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3171
Practice Address - Country:US
Practice Address - Phone:808-321-7135
Practice Address - Fax:808-200-3607
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15644225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty