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General NPI Number Information
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NPI Number | 1629948195
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Entity Type | Individual
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Provider Name | HANNAH NICOLE PETERSON LMT
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Gender | Female
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 353 N 4TH AVE STE 102
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City | POCATELLO
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State | ID
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Zip | 83201-6391
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Country | US
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Telephone | 208-705-6025
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Fax |
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Provider Business Mailing Address
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Address Line | 389 JEREMY LN
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City | BLACKFOOT
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State | ID
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Zip | 83221-1106
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Country | US
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Telephone | 719-504-2858
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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 | 6461277
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License Number State | ID
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