Healthcare Provider Details

I. General information

NPI: 1407762719
Provider Name (Legal Business Name): TIMBERLINE SPORTS MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107 W OVERLAND RD STE C
BOISE ID
83705-5189
US

IV. Provider business mailing address

5107 W OVERLAND RD
BOISE ID
83705-5216
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-4458
  • Fax:
Mailing address:
  • Phone: 208-918-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: EMILY MATHIS
Title or Position: OWNER/MANAGER
Credential: LMT, FRCMS, MFDC
Phone: 208-918-4458