Healthcare Provider Details

I. General information

NPI: 1356265615
Provider Name (Legal Business Name): MERIDIAN THERAPEUTIC MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 N LOCUST GROVE RD STE 150
MERIDIAN ID
83646-5924
US

IV. Provider business mailing address

4290 N ALESTER AVE
MERIDIAN ID
83646-6863
US

V. Phone/Fax

Practice location:
  • Phone: 530-806-5721
  • Fax:
Mailing address:
  • Phone: 530-806-5721
  • 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: STEVEN MICHAEL BREWER
Title or Position: OWNER/LICENSED MASSAGE THERAPIST
Credential: LMT
Phone: 530-806-5721