Provider Demographics
NPI:1447496914
Name:ABT, CARRIE L (LMT)
Entity type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:L
Last Name:ABT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59-742 KAMEHAMEHA HWY
Mailing Address - Street 2:B2
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9426
Mailing Address - Country:US
Mailing Address - Phone:808-722-5425
Mailing Address - Fax:
Practice Address - Street 1:59-742 KAMEHAMEHA HWY
Practice Address - Street 2:B2
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9426
Practice Address - Country:US
Practice Address - Phone:808-722-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT7070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist