Individual
MICHELLE VERSLUYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32 CARLSON AVE, REXBURG, ID 83440-1914
(208) 557-3516
(208) 549-7575
Mailing address
32 CARLSON AVE, REXBURG, ID 83440-1914
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-1462
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-1462
IDAHO STATE
ID
Enumeration date
06/07/2016
Last updated
06/07/2016
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