Provider Demographics
NPI:1215482534
Name:BREAUX, BRICE (LMT)
Entity type:Individual
Prefix:
First Name:BRICE
Middle Name:
Last Name:BREAUX
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 E TUDOR RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1144
Mailing Address - Country:US
Mailing Address - Phone:907-222-5411
Mailing Address - Fax:
Practice Address - Street 1:2665 E TUDOR RD STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1144
Practice Address - Country:US
Practice Address - Phone:907-222-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK110783225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist