Healthcare Provider Details

I. General information

NPI: 1043817513
Provider Name (Legal Business Name): JOHN BRAUNEIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17646 1ST AVE S
BURIEN WA
98148-1729
US

IV. Provider business mailing address

PO BOX 783
MILTON WA
98354-0783
US

V. Phone/Fax

Practice location:
  • Phone: 253-486-8783
  • Fax:
Mailing address:
  • Phone: 253-486-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61266030
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberRF61100386
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: