Provider Demographics
NPI:1568928208
Name:RUNYON, BRANDI NACHOLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:NACHOLE
Last Name:RUNYON
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 1:767 DANS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-9122
Mailing Address - Country:US
Mailing Address - Phone:304-235-2574
Mailing Address - Fax:
Practice Address - Street 1:183 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3601
Practice Address - Country:US
Practice Address - Phone:304-928-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2009-2556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist