Provider Demographics
NPI:1629415971
Name:BATES, ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BATES
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:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-0571
Mailing Address - Country:US
Mailing Address - Phone:208-293-2351
Mailing Address - Fax:
Practice Address - Street 1:1970 ADDISON AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5304
Practice Address - Country:US
Practice Address - Phone:208-293-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist