Doctor Name: | MR. PETER D BLACK |
NPI Number: | 1740538628 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT |
License Number: | MAT 2885 |
Business Practice Address: | 444 Hana Hwy Suite 213 Kahului, HI - 967322315 |
Business Phone Number: | 8088775587 |
Business Fax Number: | 8088718024 |
Mailing Address: | 931 Middle Rd, KULA |
State: | HI |
Postal Code: | 967907515 |
Phone Number: | 8082806470 |
Fax Number: | 8088718024 |
NPI Enumeration Date: | 08/26/2012 |
NPI Last Update Date: | 08/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MAT 2885 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |