Individual
JILL LYNN LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
700 S MAIN ST, MOSCOW, ID 83843-3056
(208) 883-4104
Mailing address
700 S MAIN ST, MOSCOW, ID 83843-3046
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-52
ID
Other
Enumeration date
01/27/2020
Last updated
01/27/2020
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