Individual
DOMINIQUE TARDIF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
413 W IDAHO ST STE 202, BOISE, ID 83702-6065
(208) 781-0452
Mailing address
413 W IDAHO ST STE 202, BOISE, ID 83702-6065
(208) 781-0452
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-775
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MASG775
LICENSE
ID
Enumeration date
11/30/2015
Last updated
10/21/2020
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