Individual
SYDNEY CASCADE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
16150 N HIGH DESERT ST STE 112, NAMPA, ID 83687-5567
(208) 442-1123
Mailing address
3270 N MITCHELL ST, BOISE, ID 83704-4173
(907) 388-7644
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3344
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-3344
MASSAGE THERAPY LICENSE
ID
Enumeration date
03/01/2022
Last updated
03/01/2022
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