Individual
MS. MARY LUCIA BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1018 IDAHO ST, LEWISTON, ID 83501-1938
(208) 305-6504
Mailing address
3130 4TH STREET D, LEWISTON, ID 83501-4342
(208) 305-6504
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00011715
WA
Other
Enumeration date
04/22/2011
Last updated
04/22/2011
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