Individual
KEVIN EARL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
3350 W AMERICANA TER STE 210A, BOISE, ID 83706-2521
(208) 509-1811
Mailing address
7520 W WILSHIRE DR, BOISE, ID 83704-7228
(208) 605-2880
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2972
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
04/05/2018
Last updated
04/05/2018
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