Healthcare Provider Details

I. General information

NPI: 1114851805
Provider Name (Legal Business Name): BROOKE WYRD LMT, CST, RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14884 NELSON ST
TRUCKEE CA
96161-1145
US

IV. Provider business mailing address

14884 NELSON ST
TRUCKEE CA
96161-1145
US

V. Phone/Fax

Practice location:
  • Phone: 530-448-6465
  • Fax:
Mailing address:
  • Phone: 530-448-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: