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Individual

TRACI DENIECE WHITE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
440 E CLARK ST STE B8, POCATELLO, ID 83201-6308
(208) 646-8257
Mailing address
1526 BENCH RD APT F7, POCATELLO, ID 83201-2453
(208) 646-8257

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
5061775
ID
225700000X
Massage Therapist
MT029533
TX

Other

Enumeration date
09/22/2023
Last updated
11/24/2024
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