Misty Lake, LMT

NPI #1134667058 in Post Falls, Idaho

Provider Information

NPI Number: 1134667058
Entity Type: Individual
Name: Misty Lake, LMT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Massage Therapist
Credential: LMT
Enumeration Date: Feb 11, 2017
Last Updated: Feb 11, 2017

Practice Location

Address: 105 E 10TH AVE
City: Post Falls
State: Idaho
ZIP Code: 83854-5125
Phone: (208) 425-6891

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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