Individual
KATHLEEN BASILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9518 W FAIRVIEW AVE, BOISE, ID 83704-8103
(208) 376-4571
Mailing address
1326 S LATAH ST, BOISE, ID 83705-2999
(325) 762-0925
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG1678
ID
Other
Enumeration date
11/26/2013
Last updated
11/26/2013
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