Individual
NATALIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT, PTA
Contact information
Practice address
1625 W STATE ST STE 100, BOISE, ID 83702-4003
(208) 336-0017
(208) 439-7657
Mailing address
1401 E BLUE TICK ST, MERIDIAN, ID 83642-7474
(208) 340-3318
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASA3541
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MASA3541
REGENCE
ID
Enumeration date
08/14/2019
Last updated
08/14/2019
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