Healthcare Provider Details

I. General information

NPI: 1841103181
Provider Name (Legal Business Name): NORTHPOINT SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30410 HIGHWAY 200 STE 100
PONDERAY ID
83852-9601
US

IV. Provider business mailing address

2058 SOUTHSIDE SCHOOL RD
COCOLALLA ID
83813-9748
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-3211
  • Fax:
Mailing address:
  • Phone: 253-766-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHANIE ANN STEPHENS
Title or Position: MANAGING MEMBER
Credential:
Phone: 253-766-7077