Individual
BRENDA G SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1545 E IRON EAGLE DR STE 103, EAGLE, ID 83616-7079
(208) 649-4405
Mailing address
10633 N SAGECREST PL, BOISE, ID 83714-9562
(404) 441-1146
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-2220
ID
Other
Enumeration date
11/16/2017
Last updated
11/16/2017
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