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General NPI Number Information
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NPI Number | 1063168052
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Entity Type | Individual
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Provider Name | BREANNE MICHELE MCKINNEY
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Gender | Female
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 5530 SW LOOP 820 STE 202
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City | FORT WORTH
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State | TX
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Zip | 76132-1864
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Country | US
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Telephone | 817-901-1151
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 BRYANT IRVIN RD # 33002
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City | FORT WORTH
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State | TX
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Zip | 76132-4135
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Country | US
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Telephone | 817-901-1511
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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 | MT120952
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License Number State | TX
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