Provider Demographics
NPI:1083728281
Name:HENRY, BRANDI NICOLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:NICOLE
Last Name:HENRY
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 1:611 7TH AVE
Mailing Address - Street 2:SUITE 99
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2131
Mailing Address - Country:US
Mailing Address - Phone:304-781-2253
Mailing Address - Fax:304-781-2254
Practice Address - Street 1:611 7TH AVE
Practice Address - Street 2:SUITE 99
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2131
Practice Address - Country:US
Practice Address - Phone:304-781-2253
Practice Address - Fax:304-781-2254
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2006-1980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist