Provider Demographics
NPI:1518395995
Name:BROWN, BRENDA (CMT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 SULSER PL
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2973
Mailing Address - Country:US
Mailing Address - Phone:703-409-2135
Mailing Address - Fax:
Practice Address - Street 1:4151 SULSER PL
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2973
Practice Address - Country:US
Practice Address - Phone:703-409-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA034984-00173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist