Individual
DENEB EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.T.
Contact information
Practice address
1315 OAKLEY AVE, BURLEY, ID 83318-1833
(208) 244-2585
Mailing address
621 DOGGETT DR, HEYBURN, ID 83336-9639
(208) 244-2585
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-1932
ID
Other
Enumeration date
10/13/2015
Last updated
10/13/2015
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