Gloria Star Jensen, MANUAL THERAPIST
Individual provider Active NPI Massage Therapist · Priest River, ID
NPI 1093456345 · NPPES record last updated Apr 1, 2022
Key facts
- NPI
- 1093456345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MAS-291 (ID)
- Practice address
- 50 Main St
Priest River, ID 83856-6758 - Phone
- (505) 402-1885
- NPI assigned
- Apr 1, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MAS-291 | ID | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Structural Synergy LLC | Single Specialty | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist |
225700000X | MAS-291 | ID | Yes |
Addresses
Primary practice location
50 Main St
Priest River, ID 83856-6758
Mailing address
50 Main St
Priest River, ID 83856-6758
Other providers in Priest River, ID
- Healing Partners Equestrian Program
- Brandon Jeffrey Holyoak
- Nate Hooper
- Intermountain Dental, PC
- Carol Jo Jenks
- Bradley D Kiriaka
- Dorlea Ann Knizley
- Delores Dianne Miller
- Inga Miller
- Ken Miller
All providers in Priest River, ID · Massage Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.