Individual
AMY LEIGH FORKAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 E PARK ST., MCCALL, ID 83638
(208) 630-3764
Mailing address
PO BOX 975, DONNELLY, ID 83615-0975
(208) 630-3764
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-1958
ID
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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