Individual
MELISSA BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
809 W CEDAR ST, POCATELLO, ID 83201-6139
(208) 557-9016
Mailing address
PO BOX 2919, POCATELLO, ID 83206-2919
(801) 472-3784
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3254
ID
Other
Enumeration date
10/02/2018
Last updated
10/02/2018
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