Individual
MIKYLA HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2060 E 25TH ST, IDAHO FALLS, ID 83404-6490
(208) 821-2105
Mailing address
2060 E 25TH ST, IDAHO FALLS, ID 83404-6490
(208) 821-2105
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2421
ID
Other
Enumeration date
01/07/2015
Last updated
01/07/2015
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