Individual
CATHLEEN MARIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
530 S HOLMES AVE, IDAHO FALLS, ID 83401-4751
(208) 405-2888
Mailing address
1831 SUNNY PINE WAY, IDAHO FALLS, ID 83404-8264
(208) 534-1975
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3540
ID
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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