Healthcare Provider Details

I. General information

NPI: 1174459242
Provider Name (Legal Business Name): JAYKOB ALLEN MORSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8182 N WAYNE DR STE A
HAYDEN ID
83835-4918
US

IV. Provider business mailing address

8182 N WAYNE DR STE A
HAYDEN ID
83835-4918
US

V. Phone/Fax

Practice location:
  • Phone: 208-603-0055
  • Fax:
Mailing address:
  • Phone: 208-603-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1581418
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: