Healthcare Provider Details

I. General information

NPI: 1659237386
Provider Name (Legal Business Name): MICHELLE S DURTSCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S MAIN ST UNIT 3
DRIGGS ID
83422-9702
US

IV. Provider business mailing address

2315 S STATELINE RD
DRIGGS ID
83422-4734
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-3090
  • Fax:
Mailing address:
  • Phone: 208-557-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5671253
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: