Provider Demographics
NPI:1992218093
Name:HUGHES, LARISSA MARIE (ATC)
Entity type:Individual
Prefix:MS
First Name:LARISSA
Middle Name:MARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 DATE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1125
Mailing Address - Country:US
Mailing Address - Phone:951-442-1017
Mailing Address - Fax:
Practice Address - Street 1:3016 DATE ST APT 5
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1125
Practice Address - Country:US
Practice Address - Phone:951-442-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAT-2732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer