Provider Demographics
NPI:1356673438
Name:ZAK, BRENDA ANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ANN
Last Name:ZAK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:22015 HWY 410 E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-4241
Mailing Address - Country:US
Mailing Address - Phone:253-891-9109
Mailing Address - Fax:253-826-0438
Practice Address - Street 1:22015 HWY 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-4241
Practice Address - Country:US
Practice Address - Phone:253-891-9109
Practice Address - Fax:253-826-0438
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist