Individual
MR. THOMAS BREITBARTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1713 FORT JESSE RD, SUITE D, NORMAL, IL 61761-6208
(309) 862-2225
(309) 862-2229
Mailing address
1713 FORT JESSE RD, SUITE D, NORMAL, IL 61761-6208
(309) 862-2225
(309) 862-2229
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.000305
IL
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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