MEDICARE: HEALING REALM THERAPEUTIC MASSAGE LLC

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

General Provider Information

NPI Number	:	1700718970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING REALM THERAPEUTIC MASSAGE LLC

Provider Business Mailing Address
First Line	:	503 HANOVER ST APT 2
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-5760
Country	:	US
Telephone Number	:	540-623-8657
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 LAFAYETTE BLVD STE 301
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-6066
Country	:	US
Telephone Number	:	540-623-8657
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LMT
Name	:	BRIANNA GABRIELLE BRANSON
Credential	:	LMT
Telephone Number	:	540-623-8657

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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