Individual
AMANDA GOULART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1042 W MILL AVE STE 104, COEUR D ALENE, ID 83814-2489
(208) 659-6526
Mailing address
2819 N JULIA ST APT C305, COEUR D ALENE, ID 83815-5250
(208) 659-6526
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-499
ID
Other
Enumeration date
11/14/2015
Last updated
11/14/2015
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