Provider Demographics
NPI:1861667040
Name:BRACKER-COBB, BRIANNE EMILY (LMT)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:EMILY
Last Name:BRACKER-COBB
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 1:1907 WAGNER ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2344
Mailing Address - Country:US
Mailing Address - Phone:626-590-3026
Mailing Address - Fax:
Practice Address - Street 1:936 E GREEN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2900
Practice Address - Country:US
Practice Address - Phone:626-590-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11438879173C00000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist