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General NPI Number Information
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NPI Number | 1326797887
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Entity Type | Organization
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Legal Business Name | BREATH OF LIFE MASSAGE, LLC
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 305 N HEATHERWILDE BLVD STE 140
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-4190
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Country | US
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Telephone | 512-798-3221
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N HEATHERWILDE BLVD STE 140
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-4190
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Country | US
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Telephone | 512-798-3221
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | BRENDA GOMEZ
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Credential | LMT, LVN
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Telephone | 310-795-4965
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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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