=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366363590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL MICHAEL MARROCCO LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 401
-----------------------------------------------------
City | SPIRIT LAKE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83869-0401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-640-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 MOONSTAR LN
-----------------------------------------------------
City | SPIRIT LAKE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-640-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MASS.MA.70131716
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------