Healthcare Provider Details

I. General information

NPI: 1063322071
Provider Name (Legal Business Name): MR. RICHARD LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 PINE ST
SANDPOINT ID
83864-8311
US

IV. Provider business mailing address

1905 PINE ST
SANDPOINT ID
83864-8311
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-7998
  • Fax: 208-255-2423
Mailing address:
  • Phone: 208-263-7998
  • Fax: 208-255-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6071871
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: