Provider Demographics
NPI:1760995898
Name:LINDER, BRETT THOMSON (BIS, CAR, CRM, CAMT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:THOMSON
Last Name:LINDER
Suffix:
Gender:M
Credentials:BIS, CAR, CRM, CAMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W BOULDER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1103
Mailing Address - Country:US
Mailing Address - Phone:907-244-6052
Mailing Address - Fax:
Practice Address - Street 1:4007 OLD SEWARD HWY STE 1000
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6065
Practice Address - Country:US
Practice Address - Phone:907-646-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK102741OtherSTATE OF ALASKA MASSAGE THERAPIST