Individual
KATIA HOPE RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
815 W CUSTER RD, MACKAY, ID 83251-5003
(208) 589-4114
Mailing address
PO BOX 306, MACKAY, ID 83251-0306
(208) 589-4114
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-1700
ID
225700000X
Massage Therapist
MT-07056
AZ
Other
Enumeration date
10/28/2017
Last updated
10/28/2017
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