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General NPI Number Information
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NPI Number | 1053191833
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Entity Type | Individual
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Provider Name | PHOEBE L BRELAND LMT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 2002 HIGHWAY 45 N STE 5
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City | COLUMBUS
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State | MS
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Zip | 39705-2247
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Country | US
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Telephone | 662-848-2565
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Fax |
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Provider Business Mailing Address
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Address Line | 317 CECIL ST
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City | COLUMBUS
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State | MS
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Zip | 39702-6349
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Country | US
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Telephone | 662-889-4009
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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 | 1402
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License Number State | MS
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