Individual
ANTHONY BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, CPT, CES
Contact information
Practice address
8631 W ARDENE ST, BOISE, ID 83709-2601
(208) 629-1904
Mailing address
8631 W ARDENE ST, BOISE, ID 83709-2601
(208) 629-1904
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6971367
ID
Other
Enumeration date
07/29/2025
Last updated
07/29/2025
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