Individual
BETHANEY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3350 W AMERICANA TER STE 360-I, BOISE, ID 83706-2521
(208) 695-7585
Mailing address
3503 W ALPINE ST, BOISE, ID 83705-1526
(208) 695-7585
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-4466
ID
Other
Enumeration date
11/30/2021
Last updated
12/07/2022
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