Healthcare Provider Details

I. General information

NPI: 1982912960
Provider Name (Legal Business Name): BREANNE MONTES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 WETMORE AVE STE 12
EVERETT WA
98201-6407
US

IV. Provider business mailing address

3206 WETMORE AVE STE 12
EVERETT WA
98201-6407
US

V. Phone/Fax

Practice location:
  • Phone: 425-789-1201
  • Fax:
Mailing address:
  • Phone: 425-879-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60140091
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: