Charles Golightly
Massage Therapist in Kuna, ID. Organization (NPI-2).
NPI number1922491513
StatusActive
Last updated in NPPESMar 6, 2015
Details
- NPI
- 1922491513
- Entity type
- Organization (NPI-2)
- Legal business name
- Charles Golightly
- Organization subpart
- No
- Enumeration date
- Mar 6, 2015
- Last updated
- Mar 6, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | MASG-1948 | ID | Yes |
Practice location
1797 N Azurite DrKuna, ID 83634-5370
Phone 208-936-9455
Mailing address
1797 N Azurite DrKuna, ID 83634-5370
Phone 208-936-9455
Authorized official
Charles Anthony Golightly
Massage Therapist
2089369455
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