| NPI | 1174320295 |
|---|---|
| Doing Business As | NORTHERN LIGHTS FUNCTIONAL THERAPY |
| Entity Type | Organization |
| Authorized Contact | SELENA RUYI BACH Sole Member 208-610-8671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2025-03-27 |