Provider Demographics
NPI:1124422399
Name:HANEY, CHEARY D (LMT)
Entity type:Individual
Prefix:
First Name:CHEARY
Middle Name:D
Last Name:HANEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHEARY
Other - Middle Name:D
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:1201 FALLS AVE E
Practice Address - Street 2:STE 32
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3405
Practice Address - Country:US
Practice Address - Phone:208-316-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMT 308225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist