Healthcare Provider Details

I. General information

NPI: 1376489146
Provider Name (Legal Business Name): ROSITA MARIE BURK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 D ST STE 200
LEWISTON ID
83501-1894
US

IV. Provider business mailing address

262 RED FIR DR
ST MARIES ID
83861-7205
US

V. Phone/Fax

Practice location:
  • Phone: 208-610-3591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7071792
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: