MEDICARE: MR. ERIC A. BROWN MASSAGE THERAPIST

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	060062	ID

General Provider Information

NPI Number	:	1194844167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC A. BROWN MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	10346 FOX BRUSH CT
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-7407
Country	:	US
Telephone Number	:	208-345-6282
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 S COLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-0932
Country	:	US
Telephone Number	:	208-484-6605
Fax Number	:	208-378-2845

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. ERIC A. BROWN MASSAGE THERAPIST” Practice Location

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