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General NPI Number Information
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NPI Number | 1093643785
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Entity Type | Individual
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Provider Name | MR. BREONE L DUPREE
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Gender | Male
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 4040 S MERIDIAN ST STE 6
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City | INDIANAPOLIS
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State | IN
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Zip | 46217-3310
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Country | US
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Telephone | 317-758-8854
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 S MERIDIAN ST STE 6
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City | INDIANAPOLIS
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State | IN
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Zip | 46217-3310
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Country | US
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Telephone | 317-758-8854
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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 | MT22207650
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License Number State | IN
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