Individual
ADELAIDA MAHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
30544 HIGHWAY 200 STE 326, PONDERAY, ID 83852-5042
(208) 205-9559
Mailing address
30544 HIGHWAY 200 STE 326, PONDERAY, ID 83852-5042
(208) 205-9559
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-2050
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MSAG-2050
LMT
ID
Enumeration date
01/07/2021
Last updated
01/07/2021
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