Provider Demographics
NPI:1467928507
Name:HIGGINBOTHAM, BRANDY (LMT)
Entity Type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:
Last Name:HIGGINBOTHAM
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 1:9149 ESTATE THOMAS STE 203
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3132
Mailing Address - Country:US
Mailing Address - Phone:403-690-4994
Mailing Address - Fax:
Practice Address - Street 1:9149 ESTATE THOMAS STE 203
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3132
Practice Address - Country:US
Practice Address - Phone:403-690-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist