Provider Demographics
NPI:1073211157
Name:ARRILLAGA, HALEIGH M (LMT)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:M
Last Name:ARRILLAGA
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 1:1050 N 16TH E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2378
Mailing Address - Country:US
Mailing Address - Phone:208-519-2685
Mailing Address - Fax:
Practice Address - Street 1:13900 W WAINWRIGHT DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5028
Practice Address - Country:US
Practice Address - Phone:208-519-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID39389698OtherREGENCE