Individual
MR. RANDALL DEAN MOSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
1018 IDAHO ST, LEWISTON, ID 83501-1938
(208) 791-1019
Mailing address
PO BOX 1958, LEWISTON, ID 83501-1464
(208) 791-1019
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
581598-09
ID
225700000X
Massage Therapist
MA60111603
WA
Other
Enumeration date
04/22/2011
Last updated
04/22/2011
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