Individual
CORWIN ALLEN WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
920 DEON DR STE A, POCATELLO, ID 83201-3069
(208) 604-3159
Mailing address
677 S 1700 W, PINGREE, ID 83262-1243
(208) 604-3159
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-1098
ID
Other
Enumeration date
01/20/2020
Last updated
01/20/2020
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