Individual
MR. BRYON KEITH STOLLE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
781 N SHADOWRIDGE AVE, EAGLE, ID 83616-5674
(208) 573-0842
Mailing address
781 N SHADOWRIDGE AVE, EAGLE, ID 83616-5674
(208) 573-0842
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-3858
ID
Other
Enumeration date
11/30/2022
Last updated
11/30/2022
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