Provider Demographics
NPI:1598168999
Name:BOREN, BRITTNEY (LMT)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:BOREN
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 1:5359 RAYMOND WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9456
Mailing Address - Country:US
Mailing Address - Phone:541-601-2379
Mailing Address - Fax:
Practice Address - Street 1:990 S FRONT ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2727
Practice Address - Country:US
Practice Address - Phone:541-664-5253
Practice Address - Fax:541-664-1165
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist