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General NPI Number Information
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NPI Number | 1821982950
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Entity Type | Organization
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Legal Business Name | BALANCED BODY MASSAGE
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 2151 W HAYDEN AVE
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City | HAYDEN
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State | ID
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Zip | 83835-7414
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Country | US
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Telephone | 208-762-6772
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Fax | 208-518-3633
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Provider Business Mailing Address
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Address Line | 2151 W HAYDEN AVE
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City | HAYDEN
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State | ID
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Zip | 83835-7414
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Country | US
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Telephone | 208-762-6772
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Fax | 208-518-3633
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Authorized Official
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Title or Position | MASSAGE THERAPIST / OFFICE MANAGER
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Name | AUBREY GASS
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Credential | LMT
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Telephone | 208-762-6772
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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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