Individual
MR. NATHAN MANDIGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ABT, CMT
Contact information
Practice address
725 N 15TH ST, BOISE, ID 83702-4020
(208) 955-8272
Mailing address
725 N 15TH ST, BOISE, ID 83702-4020
(208) 955-8272
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MX100087
ID
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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