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NPI Code Detail

MEDICARE: BREONNA MACK

MEDICARE: BREONNA MACK
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
1225700000XMassage TherapistMT136539TX

General Provider Information

NPI Number : 1720707599
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREONNA MACK
Provider Business Mailing Address
First Line : 2950 S GESSNER RD STE 208
Second Line :
City : HOUSTON
State : TX
Zip : 77063-3774
Country : US
Telephone Number : 832-382-1825
Fax Number :
Provider Business Practice Location Address
First Line : 2950 S GESSNER RD STE 208
Second Line :
City : HOUSTON
State : TX
Zip : 77063-3774
Country : US
Telephone Number : 832-382-1825
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 “ BREONNA MACK ” Practice Location

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