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General NPI Number Information
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NPI Number | 1417637729
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Entity Type | Individual
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Provider Name | MRS. KELLY BRETT
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Gender | Female
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | STE 300 312 S CEDROS AVE
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City | SOLANA BEACH
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State | CA
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Zip | 92075-1943
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Country | US
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Telephone | 858-877-1574
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Fax |
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Provider Business Mailing Address
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Address Line | 1083 RUBY CT
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City | SAN MARCOS
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State | CA
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Zip | 92078-2837
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Country | US
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Telephone | 760-214-5016
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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 | 66125
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License Number State | CA
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