Individual
JUSTIN TEAGUE ODELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
9751 N GOVERNMENT WAY STE 4, HAYDEN, ID 83835-9645
(208) 696-1330
(208) 684-7834
Mailing address
9751 N GOVERNMENT WAY STE 4, HAYDEN, ID 83835-9645
(208) 696-1330
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2891
ID
Other
Enumeration date
08/10/2020
Last updated
08/10/2020
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