Provider Demographics
NPI:1346633419
Name:WESTFALL VENTURES
Entity Type:Organization
Organization Name:WESTFALL VENTURES
Other - Org Name:MASSAGE ADDICTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:208-440-2782
Mailing Address - Street 1:12321 W HAVENCREST DR
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5796
Mailing Address - Country:US
Mailing Address - Phone:208-520-4804
Mailing Address - Fax:
Practice Address - Street 1:2572 N STOKESBERRY PL
Practice Address - Street 2:#300
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6421
Practice Address - Country:US
Practice Address - Phone:208-440-2782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty