Individual
MR. GARRETT ALEXANDER PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
30544 ID-200, PONDERAY,, ID 83852
(208) 205-9559
Mailing address
30544 ID-200, PONDERAY, ID 83852
(208) 205-9559
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-4546
ID
Other
Enumeration date
12/03/2021
Last updated
12/03/2021
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