| NPI | 1023897832 |
|---|---|
| Doing Business As | BLACK MOUNTAIN MASSAGE & WELLNESS |
| Entity Type | Organization |
| Authorized Contact | MARTHA KAY HANSEN Owner/Manager 208-201-6452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Enumeration Date | 2023-09-22 |
| Last Update Date | 2023-09-22 |