Healthcare Provider Details

I. General information

NPI: 1093638439
Provider Name (Legal Business Name): HY LAND LLC DBA HYLAND MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 E 17TH ST STE 101
IDAHO FALLS ID
83404-6519
US

IV. Provider business mailing address

3870 E 108 N
IDAHO FALLS ID
83401-6010
US

V. Phone/Fax

Practice location:
  • Phone: 208-483-0069
  • Fax:
Mailing address:
  • Phone: 208-483-0069
  • 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: RUTH CRISP
Title or Position: OWNER OPERATOR
Credential: LMT
Phone: 208-483-0069