Provider Demographics
NPI:1225767791
Name:ROOTS MASSAGE & BODYWORK LLC SUZANNE KAPLAN COL MBR
Entity Type:Organization
Organization Name:ROOTS MASSAGE & BODYWORK LLC SUZANNE KAPLAN COL MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, PTA, BS
Authorized Official - Phone:208-610-3591
Mailing Address - Street 1:PO BOX 1825
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1463
Mailing Address - Country:US
Mailing Address - Phone:208-610-3591
Mailing Address - Fax:
Practice Address - Street 1:116 E 3RD ST STE 201
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4318
Practice Address - Country:US
Practice Address - Phone:208-610-3591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty