Healthcare Provider Details

I. General information

NPI: 1164486403
Provider Name (Legal Business Name): RITA ELLEN PANKRATZ LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SELTICE WAY STE 201
POST FALLS ID
83854-7638
US

IV. Provider business mailing address

3131 S DUNLAP RD
HARRISON ID
83833-8830
US

V. Phone/Fax

Practice location:
  • Phone: 208-714-6740
  • Fax:
Mailing address:
  • Phone: 208-714-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS-4594
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: