Provider Demographics
NPI:1023606712
Name:MAHLER, ADELAIDA (LMT)
Entity type:Individual
Prefix:
First Name:ADELAIDA
Middle Name:
Last Name:MAHLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30544 HIGHWAY 200 STE 326
Mailing Address - Street 2:
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852-5042
Mailing Address - Country:US
Mailing Address - Phone:208-205-9559
Mailing Address - Fax:
Practice Address - Street 1:30544 HIGHWAY 200 STE 326
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-5042
Practice Address - Country:US
Practice Address - Phone:208-205-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-2050225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMSAG-2050OtherLMT