Provider Demographics
NPI:1538289905
Name:BREEDEN, TRACY LYNN (LMT, NCMA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:LMT, NCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4087 SABRENA AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-7004
Mailing Address - Country:US
Mailing Address - Phone:541-461-4499
Mailing Address - Fax:541-461-4499
Practice Address - Street 1:678 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2240
Practice Address - Country:US
Practice Address - Phone:541-520-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7890225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist