Healthcare Provider Details

I. General information

NPI: 1861667040
Provider Name (Legal Business Name): BRIANNE EMILY BRACKER-COBB LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 E GREEN ST SUITE 106
PASADENA CA
91106-2900
US

IV. Provider business mailing address

1907 WAGNER ST
PASADENA CA
91107-2344
US

V. Phone/Fax

Practice location:
  • Phone: 626-590-3026
  • Fax:
Mailing address:
  • Phone: 626-590-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number11438879
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number11438879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: