Individual
MISTY C KEELER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4061 IDEWILD LOOP UNIT 306, COEUR D ALENE, ID 83814-7094
(208) 620-0931
Mailing address
4061 IDEWILD LOOP UNIT 306, COEUR D ALENE, ID 83814-7094
(208) 699-0931
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3758
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-3758
LMT
ID
Enumeration date
06/05/2019
Last updated
06/05/2019
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