Provider Demographics
NPI:1114229788
Name:ORESKOVICH, BRANDI LYNN (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:ORESKOVICH
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7406
Mailing Address - Country:US
Mailing Address - Phone:970-576-1262
Mailing Address - Fax:
Practice Address - Street 1:1703 61ST AVE STE 102
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7999
Practice Address - Country:US
Practice Address - Phone:970-576-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4942225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist