Provider Demographics
NPI:1861126294
Name:BREED, CHRISTION DANIEL-CLARK (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:CHRISTION
Middle Name:DANIEL-CLARK
Last Name:BREED
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S 175TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3664
Mailing Address - Country:US
Mailing Address - Phone:206-817-3180
Mailing Address - Fax:
Practice Address - Street 1:23100 PACIFIC HWY S STE 201
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-7281
Practice Address - Country:US
Practice Address - Phone:206-824-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61313957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist