Healthcare Provider Details

I. General information

NPI: 1821982950
Provider Name (Legal Business Name): BALANCED BODY MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 W HAYDEN AVE
HAYDEN ID
83835-7414
US

IV. Provider business mailing address

2151 W HAYDEN AVE
HAYDEN ID
83835-7414
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-6772
  • Fax: 208-518-3633
Mailing address:
  • Phone: 208-762-6772
  • Fax: 208-518-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AUBREY GASS
Title or Position: MASSAGE THERAPIST / OFFICE MANAGER
Credential: LMT
Phone: 208-762-6772