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General NPI Number Information
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NPI Number | 1235549742
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Entity Type | Individual
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Provider Name | ADAM SANCHEZ L.M.T, C.M.T
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Gender | Male
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 2232 W MAIN ST
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City | BOISE
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State | ID
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Zip | 83702-4917
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Country | US
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Telephone | 208-246-9753
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 S APPLE ST APT 101
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City | BOISE
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State | ID
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Zip | 83706-6827
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Country | US
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Telephone | 208-246-9753
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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-324
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License Number State | ID
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