Individual
RUSSELL W FREESTONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
8700 W WINCHESTER DR, BOISE, ID 83704-7069
(208) 378-1377
Mailing address
8700 W WINCHESTER DR, BOISE, ID 83704-7069
(208) 378-1377
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-2217
ID
Other
Enumeration date
02/28/2017
Last updated
02/28/2017
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