Provider Demographics
NPI:1720698210
Name:GROEGER, JANET LEE (LMT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:GROEGER
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 1:10229 W LARIAT DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9557
Mailing Address - Country:US
Mailing Address - Phone:208-867-8885
Mailing Address - Fax:
Practice Address - Street 1:1151 E IRON EAGLE DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6854
Practice Address - Country:US
Practice Address - Phone:208-867-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-115225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMASG-115OtherIDAHO BUREAU OF OCCUPATIONAL LICENSES