Provider Demographics
NPI:1700274925
Name:BREKE EWTON
Entity Type:Organization
Organization Name:BREKE EWTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BREKE
Authorized Official - Middle Name:
Authorized Official - Last Name:EWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-682-2038
Mailing Address - Street 1:3756 S TIMBERLINE RD
Mailing Address - Street 2:NO. 207
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3499
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3756 S TIMBERLINE RD
Practice Address - Street 2:NO. 207
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3499
Practice Address - Country:US
Practice Address - Phone:970-682-2038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16731225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty