Individual
BROOKEANNE GREGORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1008 E 7TH ST, MOSCOW, ID 83843-3711
(801) 656-5685
Mailing address
1008 E 7TH ST, MOSCOW, ID 83843-3711
(801) 656-5685
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2749
ID
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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