Elisha Fawn Diedeerich
Individual provider Active NPI Massage Therapist · Pahoa, HI
NPI 1689471963 · NPPES record last updated Feb 25, 2025
Key facts
- NPI
- 1689471963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MAT-8824 (HI)
- Practice address
- 12-7004 Hokuao St # 50
Pahoa, HI 96778-7892 - Phone
- (808) 557-8807
- NPI assigned
- Feb 25, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MAT-8824 | HI | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Big Island Massage Network LLC | Massage Therapist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MAT-8824 | HI | Yes |
Addresses
Primary practice location
12-7004 Hokuao St # 50
Pahoa, HI 96778-7892
Mailing address
12-7004 Hokuao St # 50
Pahoa, HI 96778-7892
Phone (808) 557-8807
Other providers in Pahoa, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.