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General NPI Number Information
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NPI Number | 1013443126
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Entity Type | Organization
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Legal Business Name | BREATHE TO WELLNESS LLC
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 1335 HERRINGTON RD #2007
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City | DULUTH
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State | GA
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Zip | 30096-4683
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Country | US
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Telephone | 678-389-2088
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Fax |
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Provider Business Mailing Address
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Address Line | 1557 BUFORD DR #491811
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City | LAWRENCEVILLE
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State | GA
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Zip | 30049-0185
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSE MASSAGE THERAPIST
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Name | KIMBERLY HACKADAY
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Credential |
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Telephone | 412-996-0843
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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 |
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License Number State |
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