MEDICARE: REBECCA BRETH

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	HMS220-0013	MN

General Provider Information

NPI Number	:	1215656921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA BRETH

Provider Business Mailing Address
First Line	:	38880 95TH AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-4623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38880 95TH AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-4623
Country	:	US
Telephone Number	:	320-828-6851
Fax Number	:

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

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	08/25/2022

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Directions to “ REBECCA BRETH ” Practice Location

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