Individual
JESSICA KOWALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1740 N MILWAUKEE ST STE B, BOISE, ID 83704-7107
(208) 377-9500
(208) 377-8449
Mailing address
1740 N MILWAUKEE ST STE B, BOISE, ID 83704-7107
(208) 377-9500
(208) 377-8449
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-2110
ID
Other
Enumeration date
09/25/2014
Last updated
09/25/2014
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