Individual
AUTUMN LUKEZECH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 S EUCLID AVE STE 111, SANDPOINT, ID 83864-4916
(512) 516-9144
Mailing address
33071 HIGHWAY 200, SANDPOINT, ID 83864-9066
(512) 516-9144
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2902
ID
Other
Enumeration date
09/28/2017
Last updated
09/28/2017
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