Provider Demographics
NPI:1053191833
Name:BRELAND, PHOEBE L (LMT)
Entity type:Individual
Prefix:MRS
First Name:PHOEBE
Middle Name:L
Last Name:BRELAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 CECIL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-6349
Mailing Address - Country:US
Mailing Address - Phone:662-889-4009
Mailing Address - Fax:
Practice Address - Street 1:2002 HIGHWAY 45 N STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2247
Practice Address - Country:US
Practice Address - Phone:662-848-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1402225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist