Individual
BREEANNA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT, MLD-C
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
27902
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437273125
NPI
—
Enumeration date
01/10/2020
Last updated
04/30/2025
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