Provider Demographics
NPI:1104549815
Name:BRESLAV, ANNA (LMT, AHP, AWC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BRESLAV
Suffix:
Gender:F
Credentials:LMT, AHP, AWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9712 SHIRLAND LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6000
Mailing Address - Country:US
Mailing Address - Phone:972-979-4529
Mailing Address - Fax:866-886-1064
Practice Address - Street 1:1721 W PLANO PKWY STE 105
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8633
Practice Address - Country:US
Practice Address - Phone:214-444-8855
Practice Address - Fax:866-886-1064
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT136198225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist