Provider Demographics
NPI:1457132656
Name:GUTHRIE, IAN WILLIAM
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:WILLIAM
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1737
Mailing Address - Country:US
Mailing Address - Phone:208-853-7221
Mailing Address - Fax:208-853-5518
Practice Address - Street 1:9217 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1737
Practice Address - Country:US
Practice Address - Phone:208-853-7221
Practice Address - Fax:208-853-5518
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-2214225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist