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NPI Code Detail

MEDICARE: MYNLEY TERRY

MEDICARE: MYNLEY TERRY
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
1225700000XMassage TherapistMASP-5389ID

General Provider Information

NPI Number : 1801614839
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYNLEY TERRY
Provider Business Mailing Address
First Line : 13999 W WAINWRIGHT DR STE 201
Second Line :
City : BOISE
State : ID
Zip : 83713-1967
Country : US
Telephone Number : 208-939-0775
Fax Number :
Provider Business Practice Location Address
First Line : 13999 W WAINWRIGHT DR STE 201
Second Line :
City : BOISE
State : ID
Zip : 83713-1967
Country : US
Telephone Number : 208-939-0775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2024
Last Update Date : 09/30/2024

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Directions to “ MYNLEY TERRY ” Practice Location

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