Provider Demographics
NPI:1972959690
Name:CHRISTENSON, BREANNA RACHELL (NMT)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:RACHELL
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SCHURMAN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3137
Mailing Address - Country:US
Mailing Address - Phone:707-364-9062
Mailing Address - Fax:
Practice Address - Street 1:2314 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3257
Practice Address - Country:US
Practice Address - Phone:707-364-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist