Provider Demographics
NPI:1881135333
Name:EISENHART, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:EISENHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MANINO CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5208
Mailing Address - Country:US
Mailing Address - Phone:808-264-2846
Mailing Address - Fax:
Practice Address - Street 1:135 MANINO CIR APT 103
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5208
Practice Address - Country:US
Practice Address - Phone:808-264-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 14768225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist