Healthcare Provider Details

I. General information

NPI: 1497682736
Provider Name (Legal Business Name): STEVEN RAY AHRENDTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N MAIN ST
MOSCOW ID
83843-2629
US

IV. Provider business mailing address

PO BOX 357
JULIAETTA ID
83535-0357
US

V. Phone/Fax

Practice location:
  • Phone: 208-892-0318
  • Fax:
Mailing address:
  • Phone: 208-604-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS-3702
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: