Individual
ELIZABETH DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1503 E HIGHWAY 77, MALTA, ID 83342-8627
(208) 406-6420
Mailing address
1503 E HIGHWAY 77, MALTA, ID 83342-8627
(120) 840-6642
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA3224
ID
Other
Enumeration date
04/23/2021
Last updated
04/23/2021
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