Provider Demographics
NPI:1073158515
Name:GASS, AUBREY (LMT)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:GASS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N IDAHO ST STE 5
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8615
Mailing Address - Country:US
Mailing Address - Phone:208-714-1228
Mailing Address - Fax:
Practice Address - Street 1:1224 N IDAHO ST STE 5
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8615
Practice Address - Country:US
Practice Address - Phone:208-714-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID455329257OtherMASSAGE THERAPY