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General NPI Number Information
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NPI Number | 1164691176
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Entity Type | Organization
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Legal Business Name | BOISE THERAPEUTIC MASSAGE CENTER, LLC
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Dates
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Enumeration Date | 02/23/2008
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Last Update Date | 02/23/2008
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Provider Practice Location Address
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Address Line | 1114 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8644
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Country | US
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Telephone | 208-375-6272
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Fax | 208-375-6445
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Provider Business Mailing Address
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Address Line | 1114 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8644
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Country | US
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Telephone | 208-375-6272
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Fax | 208-375-6445
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Authorized Official
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Title or Position | OWNER
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Name | DEBRA NELSON
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Credential |
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Telephone | 208-375-6272
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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 |
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License Number State |
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