Individual
CARLY BRIANN SAMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1102 W HAYDEN AVE, SUITE A, HAYDEN, ID 83835
(208) 620-7150
(208) 620-7120
Mailing address
1102 W HAYDEN AVE, SUITE A, HAYDEN, ID 83835
(208) 620-7150
(208) 620-7120
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MA00024004
WA
225700000X
Massage Therapist
Primary
MAS4614
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222574
WA DEPT.LABOR&INDUSTRIES
WA
Enumeration date
10/09/2007
Last updated
10/12/2022
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