Destiny Noelle Lake, MASSAGE THERAPIST

NPI #1811582133 in Post Falls, Idaho

Provider Information

NPI Number: 1811582133
Entity Type: Individual
Name: Destiny Noelle Lake, MASSAGE THERAPIST
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: MASSAGE THERAPIST
Enumeration Date: Mar 8, 2021
Last Updated: Mar 8, 2021

Practice Location

Address: 1624 E SELTICE WAY
City: Post Falls
State: Idaho
ZIP Code: 83854-7022
Phone: (702) 556-6113

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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