Individual
CHENNAI MARIE HERERRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
3601 N COLE RD, BOISE, ID 83704-4410
(208) 321-7348
Mailing address
3601 N COLE RD, BOISE, ID 83704-4410
(208) 321-7348
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-773
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MASG-773
MASSAGE THERAPY LICENSE
ID
Enumeration date
12/22/2014
Last updated
12/22/2014
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