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General NPI Number Information
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NPI Number | 1174322283
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Entity Type | Individual
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Provider Name | MINA MAROVICH LMT
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Gender | Female
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/15/2025
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Provider Practice Location Address
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Address Line | 1521 E BOISE AVE
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City | BOISE
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State | ID
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Zip | 83706-5064
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Country | US
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Telephone | 208-409-5173
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Fax |
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Provider Business Mailing Address
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Address Line | 502 W HALE ST APT 101
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City | BOISE
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State | ID
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Zip | 83706-3712
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Country | US
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Telephone | 208-409-5173
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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 | MAS-5167
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License Number State | ID
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