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General NPI Number Information
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NPI Number | 1356265615
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Entity Type | Organization
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Legal Business Name | MERIDIAN THERAPEUTIC MASSAGE LLC
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 3723 N LOCUST GROVE RD STE 150
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City | MERIDIAN
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State | ID
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Zip | 83646-5924
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Country | US
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Telephone | 530-806-5721
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Fax |
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Provider Business Mailing Address
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Address Line | 4290 N ALESTER AVE
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City | MERIDIAN
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State | ID
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Zip | 83646-6863
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Country | US
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Telephone | 530-806-5721
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED MASSAGE THERAPIST
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Name | STEVEN MICHAEL BREWER
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Credential | LMT
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Telephone | 530-806-5721
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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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