Individual
KRISTA ANTRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1409 W MAIN ST, STE 100, BOISE, ID 83702-5201
(208) 871-8834
Mailing address
1901 TERRACE DR, CALDWELL, ID 83605-2248
(208) 871-8834
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3015
ID
Other
Enumeration date
01/12/2017
Last updated
01/12/2017
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