Individual
KEBBIE WHEELER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
625 W PACIFIC ST STE 5, BLACKFOOT, ID 83221-2034
(208) 680-3777
Mailing address
625 W PACIFIC ST STE 5, BLACKFOOT, ID 83221-2034
(208) 680-3777
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-4039
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-3190337
TRIWEST
ID
Enumeration date
07/29/2020
Last updated
07/29/2020
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