Provider Demographics
NPI:1003422569
Name:CHA, REEYANANA SALET (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:REEYANANA
Middle Name:SALET
Last Name:CHA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3845
Mailing Address - Country:US
Mailing Address - Phone:262-751-4926
Mailing Address - Fax:
Practice Address - Street 1:12201 W BURLEIGH ST STE 6
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3102
Practice Address - Country:US
Practice Address - Phone:262-751-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4818-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist