Provider Demographics
NPI:1952859894
Name:HARTZELL-BREZINA, CHENOAH AERIE (LMT)
Entity Type:Individual
Prefix:
First Name:CHENOAH
Middle Name:AERIE
Last Name:HARTZELL-BREZINA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7025
Mailing Address - Country:US
Mailing Address - Phone:541-973-9461
Mailing Address - Fax:
Practice Address - Street 1:924 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7025
Practice Address - Country:US
Practice Address - Phone:541-973-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22546225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist