Provider Demographics
NPI:1073846036
Name:VARNADO, BRANDI NICOLE ARIAS (MPT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE ARIAS
Last Name:VARNADO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4305
Mailing Address - Country:US
Mailing Address - Phone:575-309-6943
Mailing Address - Fax:575-461-8033
Practice Address - Street 1:2400 S 8TH ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3726
Practice Address - Country:US
Practice Address - Phone:575-461-4344
Practice Address - Fax:575-461-8033
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist