Provider Demographics
NPI:1467803577
Name:BITTNER, BRENNA RAE (MA60663284)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:RAE
Last Name:BITTNER
Suffix:
Gender:F
Credentials:MA60663284
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 126TH PL NE APT A202
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3232
Mailing Address - Country:US
Mailing Address - Phone:206-396-6276
Mailing Address - Fax:
Practice Address - Street 1:37 103RD AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5689
Practice Address - Country:US
Practice Address - Phone:425-451-1171
Practice Address - Fax:425-451-1232
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60663284225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist