NPIMap

Individual provider Active NPI

Phillip Bruneau, LMT

  • Massage Therapist
  • Kailua Kona, HI
National Provider Identifier
1861784092
Registry record updated May 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
4994 Issued in HI
Practice address
75-5741 Kuakini Hwy
#A
Kailua Kona, HI 96740-3724
Phone
(808) 327-5664
NPI assigned
May 5, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 4994 HI Primary

Addresses

Primary practice location

75-5741 Kuakini Hwy
#A
Kailua Kona, HI 96740-3724

Mailing address

75-5741 Kuakini Hwy
#A
Kailua Kona, HI 96740-3724
Phone (808) 327-5664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4994HIMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pau Hana Massage LLC Massage Therapist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304553600000",
    "number": "1861784092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-5741 KUAKINI HWY",
            "address_2": "#A",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967403724",
            "telephone_number": "808-327-5664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-5741 KUAKINI HWY",
            "address_2": "#A",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967403724",
            "telephone_number": "808-327-5664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNEAU",
        "first_name": "PHILLIP",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-05",
        "last_updated": "2011-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "HI",
            "license": "4994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua Kona, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.