Individual
MISS MIRANDA MCBROOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1150 W STATE ST, 220, BOISE, ID 83702-5327
(541) 519-7478
Mailing address
1809 W MALAD LN, BOISE, ID 83705-4479
(541) 519-7478
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2393
ID
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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