Provider Demographics
NPI:1518577048
Name:MUIR, BRIGETTE MERCEDES
Entity Type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:MERCEDES
Last Name:MUIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1210
Mailing Address - Country:US
Mailing Address - Phone:301-917-4549
Mailing Address - Fax:
Practice Address - Street 1:6111 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1210
Practice Address - Country:US
Practice Address - Phone:301-917-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist