Individual
MS. LISA STUBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
2688 HILLVIEW DR, POCATELLO, ID 83201-2503
(208) 244-5658
Mailing address
2688 HILLVIEW DR, POCATELLO, ID 83201-2503
(208) 244-5658
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
BL7614
ID
Other
Enumeration date
10/31/2009
Last updated
10/31/2009
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