Provider Demographics
NPI:1306118575
Name:KATHLEEN, BRIANNA (LMT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:KATHLEEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:KATHLEEN
Other - Last Name:DUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:600 S OAK STREET, TRL 3
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541
Mailing Address - Country:US
Mailing Address - Phone:714-585-2876
Mailing Address - Fax:
Practice Address - Street 1:718 N BEELINE HWY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-3796
Practice Address - Country:US
Practice Address - Phone:714-585-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist