Individual
MELINDA DEMEMBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11152 W STATE ST, SUITE 103, STAR, ID 83669-5216
(208) 703-5088
Mailing address
628 HARPY AVE, MIDDLETON, ID 83644-5967
(208) 703-5088
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-785
ID
Other
Enumeration date
01/28/2015
Last updated
01/28/2015
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