Individual
KATHERINE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1409 W MAIN ST STE 100, BOISE, ID 83702-5202
(208) 520-7809
Mailing address
1409 W MAIN ST STE 100, BOISE, ID 83702-5202
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-1308
ID
Other
Enumeration date
01/11/2017
Last updated
01/11/2017
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