Provider Demographics
NPI:1073129037
Name:MALEWSKI, BRANDI M (LMT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:M
Last Name:MALEWSKI
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 1:113 OLD GICK RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9451
Mailing Address - Country:US
Mailing Address - Phone:518-886-9977
Mailing Address - Fax:
Practice Address - Street 1:113 OLD GICK RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9451
Practice Address - Country:US
Practice Address - Phone:518-886-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist