Individual
MR. BLAIR WILLIAM MATTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
45 E LITTLE AVE, DRIGGS, ID 83422-5138
(208) 354-8637
Mailing address
PO BOX 1043, VICTOR, ID 83455-1031
(208) 881-4540
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS909
ID
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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