Individual
KEVIN BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT,PTA
Contact information
Practice address
3155 CHANNING WAY, IDAHO FALLS, ID 83404-7874
(208) 557-8962
Mailing address
440 E 24TH ST, IDAHO FALLS, ID 83404-6946
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-4984
ID
Other
Enumeration date
08/29/2024
Last updated
08/29/2024
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