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General NPI Number Information
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NPI Number | 1003394305
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Entity Type | Individual
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Provider Name | JANELL M BRUESCH LMT
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Gender | Female
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 1101 AVENUE D
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City | SNOHOMISH
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State | WA
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Zip | 98290-2083
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Country | US
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Telephone | 20-936-0563
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Fax |
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Provider Business Mailing Address
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Address Line | 3325 GORIN DR
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City | EVERETT
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State | WA
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Zip | 98208-3057
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Country | US
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Telephone | 425-397-1683
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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 | MA60878890
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License Number State | WA
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