Provider Demographics
NPI:1588899298
Name:SAPOLU, MATI (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:MATI
Middle Name:
Last Name:SAPOLU
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 1:1019 UNIVERSITY AVENUE
Mailing Address - Street 2:SUITE T02
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826
Mailing Address - Country:US
Mailing Address - Phone:808-203-0776
Mailing Address - Fax:
Practice Address - Street 1:1019 UNIVERSITY AVE
Practice Address - Street 2:SUITE T02
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1509
Practice Address - Country:US
Practice Address - Phone:808-203-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMT8600171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HILMT8600OtherMASSAGE THERAPIST