Healthcare Provider Details

I. General information

NPI: 1346783131
Provider Name (Legal Business Name): RACHEL BRAKEBILL MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 E SUNSHINE ST SUITE F
SPRINGFIELD MO
65809-2813
US

IV. Provider business mailing address

3534 E. SUNSHINE ST. SUITE F
SPRINGFIELD MO
65804
US

V. Phone/Fax

Practice location:
  • Phone: 417-840-7291
  • Fax:
Mailing address:
  • Phone: 417-840-7291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2008035578
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: