Individual
DESTINY NOELLE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
1624 E SELTICE WAY, POST FALLS, ID 83854-7022
(702) 556-6113
Mailing address
1624 E SELTICE WAY, POST FALLS, ID 83854-7022
(208) 777-0128
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3720
ID
Other
Enumeration date
03/08/2021
Last updated
03/08/2021
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