Organization
IDAHO SPORT MASSAGE LLC
Active
Other names
Idaho Sport Massage
Organization subpart
No
Provider details
NPI number
Authorized official
MINDY CERVANTES (OWNER)
(435) 580-9461
Entity
Organization
Contact information
Practice address
675 YELLOWSTONE AVE # 1, POCATELLO, ID 83201-4511
(208) 478-1488
Mailing address
4846 HIRAM AVE, CHUBBUCK, ID 83202-3018
(435) 580-9461
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
07/11/2024
Last updated
10/24/2024
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