Provider Demographics
NPI:1992003628
Name:REYES, BREEAN CECILY (LMT)
Entity Type:Individual
Prefix:
First Name:BREEAN
Middle Name:CECILY
Last Name:REYES
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:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-0883
Mailing Address - Country:US
Mailing Address - Phone:406-297-3422
Mailing Address - Fax:
Practice Address - Street 1:343 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9059
Practice Address - Country:US
Practice Address - Phone:406-297-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1108225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist