Provider Demographics
NPI:1386178390
Name:CROTINGER, BRIANA (LMT)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:CROTINGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N HENRY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6436
Mailing Address - Country:US
Mailing Address - Phone:208-651-4442
Mailing Address - Fax:
Practice Address - Street 1:520 E COEUR DALENE AVE RM 2
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2873
Practice Address - Country:US
Practice Address - Phone:208-651-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-2575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist