Individual
BRADLEY SCOTT BROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
8109 N WAYNE BLVD, HAYDEN, ID 83835-5031
(208) 667-7463
(208) 762-6385
Mailing address
8109 N WAYNE BLVD, HAYDEN, ID 83835-5031
(208) 667-7463
(208) 762-6385
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-2367
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MASG-2367
MT LICENSE
ID
Enumeration date
07/15/2019
Last updated
07/15/2019
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