Provider Demographics
NPI:1336617372
Name:COEUR D ALENE MASSAGE SCHOOL LLC
Entity Type:Organization
Organization Name:COEUR D ALENE MASSAGE SCHOOL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEACHLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:208-771-5735
Mailing Address - Street 1:1625 N 4TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6178
Mailing Address - Country:US
Mailing Address - Phone:208-765-1075
Mailing Address - Fax:
Practice Address - Street 1:1625 N 4TH ST STE 203
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6178
Practice Address - Country:US
Practice Address - Phone:208-765-1075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty