Crystal M Breedlove, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60557076 Issued in WA

Practice address

12214 SE Mill Plain Blvd Ste 101
Vancouver, WA 98684-6019

Phone

(360) 944-1800

NPI assigned

Jul 30, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1532908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1366920670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12214 SE MILL PLAIN BLVD STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846019",
            "telephone_number": "360-944-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12214 SE MILL PLAIN BLVD STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986846019",
            "telephone_number": "360-944-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREEDLOVE",
        "first_name": "CRYSTAL",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-30",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60557076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSAGE LICHENS NUMBER",
            "identifier": "MA60557076",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMT LICENSE NUMBER",
            "identifier": "MA60557076",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reba Brazell
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• Erin Therese Brecht
• Miranda M Breeden, M.S., CCC-SLP
• Thomas A Breitenbauch
• Trista Faye Breitenbauch, SUDP
• Amanda Pauline Breland
• Laurence F. Brennan, MSW
• Preston Brennan

• Massage Therapist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; 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.