Individual
DONALD W POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
13 N BRIDGE ST, SAINT ANTHONY, ID 83445-2110
(208) 351-0191
Mailing address
549 W 1ST N, SAINT ANTHONY, ID 83445-1303
(208) 351-0191
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2642
ID
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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