Provider Demographics
NPI:1194844167
Name:BROWN, ERIC A (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10346 FOX BRUSH CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-7407
Mailing Address - Country:US
Mailing Address - Phone:208-345-6282
Mailing Address - Fax:
Practice Address - Street 1:166 S COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0932
Practice Address - Country:US
Practice Address - Phone:208-484-6605
Practice Address - Fax:208-378-2845
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID060062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist