Provider Demographics
NPI:1386258465
Name:SCALES, BREYANE SHAWNEEN
Entity type:Individual
Prefix:
First Name:BREYANE
Middle Name:SHAWNEEN
Last Name:SCALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-1157
Mailing Address - Country:US
Mailing Address - Phone:509-713-9677
Mailing Address - Fax:
Practice Address - Street 1:3124 LAKE DR APT 33
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2844
Practice Address - Country:US
Practice Address - Phone:509-713-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist