Provider Demographics
NPI:1861919177
Name:SOMA FLEX THERAPEUTICS, LLC
Entity type:Organization
Organization Name:SOMA FLEX THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEGGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:208-972-1910
Mailing Address - Street 1:4224 S FEDERAL WAY
Mailing Address - Street 2:V-106
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3050 N LAKEHARBOR LN STE 164
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6906
Practice Address - Country:US
Practice Address - Phone:208-972-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT121623225700000X
IDMAS-2721225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty