Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MASG-457 | ID |
NPI | 1003372384 |
---|---|
Provider Name | Michele Murphy |
First Address | Troy, ID 83871-9634 |
Second Address | Moscow, ID 83843-3182 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2019 |
Last Update Date | 12/02/2019 |