Healthcare Provider Details

I. General information

NPI: 1962633768
Provider Name (Legal Business Name): BRITNII LEIGH-ANNE ISAACKS L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3488 PECK AVE SE
SALEM MARION
97302
UM

IV. Provider business mailing address

3488 PECK AVE SE
SALEM OR
97302-3312
US

V. Phone/Fax

Practice location:
  • Phone: 503-857-8196
  • Fax:
Mailing address:
  • Phone: 503-857-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number15091
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: