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General NPI Number Information
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NPI Number | 1023816410
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Entity Type | Individual
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Provider Name | MALLORY CAMPBELL MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 8 S STATE ST
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City | PRESTON
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State | ID
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Zip | 83263-1243
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Country | US
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Telephone | 208-776-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 2845 W 7200 N
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City | PRESTON
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State | ID
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Zip | 83263-5016
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Country | US
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Telephone | 208-776-0027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAS3498
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License Number State | ID
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