Provider Demographics
NPI:1013443126
Name:BREATHE TO WELLNESS LLC
Entity Type:Organization
Organization Name:BREATHE TO WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKADAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-996-0843
Mailing Address - Street 1:1557 BUFORD DR
Mailing Address - Street 2:#491811
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1335 HERRINGTON RD
Practice Address - Street 2:#2007
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4683
Practice Address - Country:US
Practice Address - Phone:678-389-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty