Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MASG-470 | ID |
NPI | 1003353590 |
---|---|
Provider Name | Lesley March |
First Address | Boise, ID 83702-5201 |
Second Address | Boise, ID 83702-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2017 |
Last Update Date | 23/01/2017 |