Doctor Name: | MR. BLAIR WILLIAM MATTSON |
NPI Number: | 1629498183 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT |
License Number: | MAS909 |
Business Practice Address: | 45 E Little Ave Driggs, ID - 834225138 |
Business Phone Number: | 2083548637 |
Business Fax Number: | |
Mailing Address: | Po Box 1043, VICTOR |
State: | ID |
Postal Code: | 834551031 |
Phone Number: | 2088814540 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2014 |
NPI Last Update Date: | 04/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MAS909 |
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. |