MEDICARE: MRS. PHOEBE L BRELAND LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	1402	MS

General Provider Information

NPI Number	:	1053191833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHOEBE L BRELAND LMT

Provider Business Mailing Address
First Line	:	317 CECIL ST
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-6349
Country	:	US
Telephone Number	:	662-889-4009
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 HIGHWAY 45 N STE 5
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2247
Country	:	US
Telephone Number	:	662-848-2565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	10/10/2023

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