Individual
DEREK WASEC ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3046 S BOWN WAY STE A, BOISE, ID 83706-5499
(208) 318-6561
Mailing address
217 S POWERLINE RD, NAMPA, ID 83686-5440
(208) 318-6561
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-4868
ID
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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