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General NPI Number Information
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NPI Number | 1861919177
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Entity Type | Organization
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Legal Business Name | SOMA FLEX THERAPEUTICS, LLC
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 08/28/2017
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Provider Practice Location Address
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Address Line | 3050 N LAKEHARBOR LN STE 164
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City | BOISE
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State | ID
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Zip | 83703-6906
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Country | US
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Telephone | 208-972-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 4224 S FEDERAL WAY V-106
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City | BOISE
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State | ID
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Zip | 83716-5577
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TANIA YEGGE
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Credential | LMT
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Telephone | 208-972-1910
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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 | MT121623
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAS-2721
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License Number State | ID
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