Provider Demographics
NPI:1235958216
Name:STAR THERAPEUTIC MASSAGE LLC
Entity type:Organization
Organization Name:STAR THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI-LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-573-0448
Mailing Address - Street 1:175 S LANGER LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5634
Mailing Address - Country:US
Mailing Address - Phone:208-573-0448
Mailing Address - Fax:
Practice Address - Street 1:175 S LANGER LAKE WAY
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5634
Practice Address - Country:US
Practice Address - Phone:208-573-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty