Individual
ANDREW NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
30544 HIGHWAY 200 STE 326, PONDERAY, ID 83852-5042
(208) 205-9559
Mailing address
PO BOX 85, HOPE, ID 83836-0085
(909) 486-6436
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-5206
ID
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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