Individual
JASPER GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 S EUCLID AVE STE 201, SANDPOINT, ID 83864-4916
(208) 502-0728
Mailing address
102 S EUCLID AVE STE 201, SANDPOINT, ID 83864-4916
(208) 502-0728
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-4837
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-4837
LMT
ID
Enumeration date
08/29/2022
Last updated
08/29/2022
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