Provider Demographics
NPI:1699103317
Name:MONROE, RACHAEL MARLENE (LMT)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:MARLENE
Last Name:MONROE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:RACHAEL
Other - Middle Name:MARLENE
Other - Last Name:ADAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:619 S WASHINGTON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3090
Mailing Address - Country:US
Mailing Address - Phone:208-883-4300
Mailing Address - Fax:208-883-4311
Practice Address - Street 1:619 S WASHINGTON ST
Practice Address - Street 2:STE 101
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3090
Practice Address - Country:US
Practice Address - Phone:208-883-4300
Practice Address - Fax:208-883-4311
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist