Healthcare Provider Details

I. General information

NPI: 1467803577
Provider Name (Legal Business Name): BRENNA RAE BITTNER MA60663284
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 103RD AVE NE
BELLEVUE WA
98004-5689
US

IV. Provider business mailing address

811 126TH PL NE APT A202
BELLEVUE WA
98005-3232
US

V. Phone/Fax

Practice location:
  • Phone: 425-451-1171
  • Fax: 425-451-1232
Mailing address:
  • Phone: 206-396-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60663284
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: