Provider Demographics
NPI:1972959690
Name:CHRISTENSON, BREANNA RACHELL (NMT , CMT)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:RACHELL
Last Name:CHRISTENSON
Suffix:
Gender:
Credentials:NMT , CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4130
Mailing Address - Country:US
Mailing Address - Phone:707-364-9062
Mailing Address - Fax:707-868-6059
Practice Address - Street 1:207 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3435
Practice Address - Country:US
Practice Address - Phone:707-364-9062
Practice Address - Fax:707-868-6059
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist