Provider Demographics
NPI:1003053588
Name:CREDEUR, BRANDY LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LYNN
Last Name:CREDEUR
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 1:13740 RESEARCH BLVD. BLDG B, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1884
Mailing Address - Country:US
Mailing Address - Phone:512-826-2115
Mailing Address - Fax:
Practice Address - Street 1:13740 RESEARCH BLVD. BLDG B, SUITE 3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1885
Practice Address - Country:US
Practice Address - Phone:512-826-2115
Practice Address - Fax:512-826-2115
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX034422225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist