Provider Demographics
NPI:1356196935
Name:STEVES, BREANNA (LMT)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:STEVES
Suffix:
Gender:X
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4001
Mailing Address - Country:US
Mailing Address - Phone:503-678-9513
Mailing Address - Fax:888-538-0460
Practice Address - Street 1:1025 2ND ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4001
Practice Address - Country:US
Practice Address - Phone:503-678-9513
Practice Address - Fax:888-538-0460
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26643225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist