Brenda Lee Waalkens-Breedlove, CMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

23882 Issued in CA

Practice address

22280 City Center Dr Apt 4225
Hayward, CA 94541-2814

Phone

(510) 397-8177

NPI assigned

Sep 18, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1013523752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22280 CITY CENTER DR APT 4225",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945412814",
            "telephone_number": "510-209-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22280 CITY CENTER DR APT 4225",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945412814",
            "telephone_number": "510-397-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAALKENS-BREEDLOVE",
        "first_name": "BRENDA",
        "middle_name": "LEE",
        "credential": "CMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-18",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "23882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAMTC",
            "identifier": "23882",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "breedlovemedmassage@gmail.com",
            "affiliation": "N",
            "endpointDescription": "breedlovemedmassagw@gmail.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "22280 City Center Dr Apt 4225",
            "city": "Hayward",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945412814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Massage Therapist in Hayward, CA
• Providers in Hayward, CA by specialty
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.