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General NPI Number Information
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NPI Number | 1386430262
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Entity Type | Individual
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Provider Name | MICHAEL WILLIAM MURRAY
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Gender | Male
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 5107 W OVERLAND RD STE C
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City | BOISE
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State | ID
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Zip | 83705-5189
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Country | US
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Telephone | 208-918-4458
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Fax |
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Provider Business Mailing Address
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Address Line | 19349 KIOWA CREEK WAY
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City | CALDWELL
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State | ID
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Zip | 83605-7526
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Country | US
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Telephone | 951-219-3122
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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 | 6671035
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License Number State | ID
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