Individual
KENNETH ANDREW MCMANUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5909 W STATE ST, BOISE, ID 83703-3039
(208) 343-7700
(208) 331-2591
Mailing address
11574 W AZURE DR, BOISE, ID 83713-7879
(435) 554-8093
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2730
ID
Other
Enumeration date
02/27/2018
Last updated
03/17/2018
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