MEDICARE: BREANNE LARAE SCHLEISMAN

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	MT.0011275	CO

General Provider Information

NPI Number	:	1902787575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNE LARAE SCHLEISMAN

Provider Business Mailing Address
First Line	:	4745 BOARDWALK DR UNIT C1
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3769
Country	:	US
Telephone Number	:	970-207-4066
Fax Number	:

Provider Business Practice Location Address
First Line	:	4745 BOARDWALK DR UNIT C1
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3769
Country	:	US
Telephone Number	:	970-207-4066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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