Individual
DIANA REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
82 E STATE ST STE D, EAGLE, ID 83616-6048
(208) 739-7650
Mailing address
19881 ADIRONDACK WAY, CALDWELL, ID 83605-8053
(208) 739-7650
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2679
ID
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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