Provider Demographics
NPI:1497492375
Name:QUESENBERRY, BRIAN (LMT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:QUESENBERRY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 INDIES RD
Mailing Address - Street 2:
Mailing Address - City:RAMROD KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-5404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:913 INDIES RD
Practice Address - Street 2:
Practice Address - City:RAMROD KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-5404
Practice Address - Country:US
Practice Address - Phone:717-779-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA96887225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist