Individual
JANET LEE GROEGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1151 E IRON EAGLE DR, EAGLE, ID 83616-6854
(208) 867-8885
Mailing address
10229 W LARIAT DR, BOISE, ID 83714-9557
(208) 867-8885
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-115
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MASG-115
IDAHO BUREAU OF OCCUPATIONAL LICENSES
ID
Enumeration date
08/09/2020
Last updated
08/09/2020
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