Provider Demographics
NPI:1285872283
Name:BREITMUN, MOLLY GENEVIEVE (LMP)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:GENEVIEVE
Last Name:BREITMUN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:GENEVIEVE
Other - Last Name:GARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2625 B PARKMONT LN SW
Mailing Address - Street 2:STE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5751
Mailing Address - Country:US
Mailing Address - Phone:360-943-2940
Mailing Address - Fax:
Practice Address - Street 1:2625 B PARKMONT LN SW
Practice Address - Street 2:STE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5751
Practice Address - Country:US
Practice Address - Phone:360-943-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60066736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist