Provider Demographics
NPI:1962037663
Name:REGALADO, ADRIANNA (LMT)
Entity Type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:
Last Name:REGALADO
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 1:86 S PEPPERMINT DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9129
Mailing Address - Country:US
Mailing Address - Phone:208-697-3840
Mailing Address - Fax:
Practice Address - Street 1:2308 N COLE RD STE H
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7361
Practice Address - Country:US
Practice Address - Phone:208-697-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist