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Individual

EMILY T WITSIL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.M.T.

Contact information

Practice address
9217 W STATE ST, BOISE, ID 83714-1737
(208) 853-7221
(208) 853-5518
Mailing address
717 W HAYS ST APT 7, BOISE, ID 83702-5557
(302) 745-4714
(208) 853-5518

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-1526
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MAS-1526
STATE OF IDAHO
ID
Enumeration date
02/25/2014
Last updated
02/25/2014
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