Provider Demographics
NPI:1700563087
Name:IDAHO MASSAGE LLC
Entity type:Organization
Organization Name:IDAHO MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:TUNDE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SZEKERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-830-0106
Mailing Address - Street 1:539 S FITNESS PL #500
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-507-8119
Mailing Address - Fax:
Practice Address - Street 1:539 S FITNESS PL #500
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:208-507-8119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty