Healthcare Provider Details

I. General information

NPI: 1447495403
Provider Name (Legal Business Name): JOAN L. HURST JOAN HURST, ABT.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN HURST JOAN HURST

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N 15TH ST
BOISE ID
83702-4020
US

IV. Provider business mailing address

825 N ARMSTRONG PL
BOISE ID
83704-8095
US

V. Phone/Fax

Practice location:
  • Phone: 208-388-0206
  • Fax: 208-388-0206
Mailing address:
  • Phone: 208-761-5797
  • 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:
Title or Position:
Credential:
Phone: