Doctor Name: | PATRICIA HETRICK |
NPI Number: | 1164812368 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | MASG-727 |
Business Practice Address: | 2300 S Orchard St Ste. A Boise, ID - 837056722 |
Business Phone Number: | 2083831070 |
Business Fax Number: | 2083833702 |
Mailing Address: | 2300 S Orchard St, Ste. A BOISE |
State: | ID |
Postal Code: | 837056722 |
Phone Number: | 2083831070 |
Fax Number: | 2083833702 |
NPI Enumeration Date: | 01/27/2015 |
NPI Last Update Date: | 01/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MASG-727 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |