Individual
MS. STACI LEANNE TRUBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
717 'D' STREET, LEWISTON, ID 83501
(208) 743-1424
(208) 743-2803
Mailing address
416 3RD STREET, LEWISTON, ID 83501
(208) 790-2538
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
08-002760
ID
Other
Enumeration date
05/18/2011
Last updated
05/18/2011
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