MEDICARE: CONNECTED BRANCHES HOLISTIC WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1417727629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTED BRANCHES HOLISTIC WELLNESS LLC

Provider Business Mailing Address
First Line	:	23420 PORCINA WAY
Second Line	:
City	:	COLUMBIA
State	:	CA
Zip	:	95310-9715
Country	:	US
Telephone Number	:	209-400-2155
Fax Number	:

Provider Business Practice Location Address
First Line	:	23420 PORCINA WAY
Second Line	:
City	:	COLUMBIA
State	:	CA
Zip	:	95310-9715
Country	:	US
Telephone Number	:	209-400-2155
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRETT LOVELL-RIOS
Credential	:	CMT
Telephone Number	:	925-784-4589

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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