=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346633419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTFALL VENTURES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2015
-----------------------------------------------------
Last Update Date | 03/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2572 N STOKESBERRY PL #300
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83646-6421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-440-2782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12321 W HAVENCREST DR
-----------------------------------------------------
City | STAR
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83669-5796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-520-4804
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. KIMBERLY PLATTER
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 208-440-2782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------