Provider Demographics
NPI:1134254097
Name:BREHM, CHRISTLE R (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTLE
Middle Name:R
Last Name:BREHM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHRISTLE
Other - Middle Name:R
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:23100 PACIFIC HWY S STE 201
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-7281
Mailing Address - Country:US
Mailing Address - Phone:206-824-9500
Mailing Address - Fax:206-824-9654
Practice Address - Street 1:619 S 225TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6823
Practice Address - Country:US
Practice Address - Phone:253-332-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010738225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0007840142Medicare UPIN
WA5328EAMedicare UPIN