MEDICARE: LILY BALANOFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	2671941	ID

General Provider Information

NPI Number	:	1033035878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY BALANOFF

Provider Business Mailing Address
First Line	:	521 E 41ST ST APT 302
Second Line	:
City	:	GARDEN CITY
State	:	ID
Zip	:	83714-6625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 E 43RD ST STE 1223
Second Line	:
City	:	GARDEN CITY
State	:	ID
Zip	:	83714-4925
Country	:	US
Telephone Number	:	208-562-7325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2026
Last Update Date	:	06/25/2026

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Directions to “ LILY BALANOFF ” Practice Location

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