Provider Demographics
NPI:1174712616
Name:GULBRANDSON, AMY KRISTINE (LMT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTINE
Last Name:GULBRANDSON
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 1:1292 LORI DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4561
Mailing Address - Country:US
Mailing Address - Phone:352-650-8446
Mailing Address - Fax:352-592-7575
Practice Address - Street 1:1292 LORI DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4561
Practice Address - Country:US
Practice Address - Phone:352-650-8446
Practice Address - Fax:352-592-7575
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist