Provider Demographics
NPI:1386812469
Name:BREESE, MICHELLE L (LMP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BREESE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28815 PACIFIC HWY SO
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-941-6977
Mailing Address - Fax:253-941-6929
Practice Address - Street 1:28815 PACIFIC HWY S
Practice Address - Street 2:SUITE 6
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-3906
Practice Address - Country:US
Practice Address - Phone:253-941-6977
Practice Address - Fax:253-941-6929
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021552225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist