Individual
REBECCA A. PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, NCTMB
Contact information
Practice address
500 E SKI HILL RD, DRIGGS, ID 83422
(208) 354-2871
Mailing address
10175 SNOWY LN, TETONIA, ID 83452-4962
(208) 390-3418
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-235
ID
Other
Enumeration date
12/05/2014
Last updated
12/05/2014
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