Individual
KATIE LEE WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1624 E SELTICE WAY, POST FALLS, ID 83854-7022
(208) 777-0128
Mailing address
1624 E SELTICE WAY, POST FALLS, ID 83854-7022
(208) 777-0128
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2956
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-2956
BUREAU OF OCCUPATIONAL LICENSE
ID
Enumeration date
12/15/2020
Last updated
12/16/2020
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