Individual
MISTY ZHENIA CONNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
118 N 7TH ST STE B8, COEUR D ALENE, ID 83814-2704
(208) 215-4594
(208) 561-7752
Mailing address
PO BOX 2226, HAYDEN, ID 83835-2226
(208) 446-6749
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-891
ID
Other
Enumeration date
12/30/2016
Last updated
09/03/2021
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