MEDICARE: DAVID BRUST NCLMT

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	225700000X	AK

General Provider Information

NPI Number	:	1407285471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BRUST NCLMT

Provider Business Mailing Address
First Line	:	1610 DIMOND DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-1304
Country	:	US
Telephone Number	:	907-727-3399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 DIMOND DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-1304
Country	:	US
Telephone Number	:	907-727-3399
Fax Number	:

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

Provider Enumeration Date	:	11/10/2013
Last Update Date	:	03/07/2016

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Directions to “ DAVID BRUST NCLMT” Practice Location

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