Provider Demographics
NPI:1831861046
Name:HANCOCK, CLOIS PAUL (LMT, NAC)
Entity type:Individual
Prefix:
First Name:CLOIS
Middle Name:PAUL
Last Name:HANCOCK
Suffix:
Gender:
Credentials:LMT, NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8882 N GOVERNMENT WAY STE P
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9282
Mailing Address - Country:US
Mailing Address - Phone:509-904-2330
Mailing Address - Fax:
Practice Address - Street 1:8882 N GOVERNMENT WAY STE P
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9282
Practice Address - Country:US
Practice Address - Phone:208-254-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014647225700000X
IDMASG-812225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist