Idaho Massage LLC

NPI #1134902844 in Eagle, Idaho

Provider Information

NPI Number: 1134902844
Entity Type: Organization
Organization Name: Idaho Massage LLC
Primary Specialty: Massage Therapist
Enumeration Date: Aug 16, 2023
Last Updated: Aug 16, 2023

Practice Location

Address: 539 S FITNESS PL #150
City: Eagle
State: Idaho
ZIP Code: 83616
Phone: (208) 507-8119

Authorized Official

Name: TANEESHA MISHEL KNIGHT, LMT
Title: MASSAGE THERAPIST
Phone: (702) 321-1441

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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