Individual
TERRI LEA QUILICI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
175 N 300 W, BLACKFOOT, ID 83221-5617
(208) 681-7546
Mailing address
175 N 300 W, BLACKFOOT, ID 83221-5617
(208) 681-7546
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3326
ID
Other
Enumeration date
08/27/2018
Last updated
08/27/2018
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