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General NPI Number Information
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NPI Number | 1003020850
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Entity Type | Individual
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Provider Name | JOELLE MARIE BENOIT BREKHUS LMP
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1519 BASIN ST SW
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City | EPHRATA
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State | WA
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Zip | 98823-2135
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Country | US
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Telephone | 509-754-2461
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Fax | 509-754-2462
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Provider Business Mailing Address
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Address Line | 519 1ST AVE SW
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City | EPHRATA
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State | WA
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Zip | 98823-1804
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Country | US
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Telephone | 509-754-6387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00019749
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License Number State | WA
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