Provider Demographics
NPI:1629199757
Name:MUNYON, BRENDA LEE (LMT)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:MUNYON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1047 HOWELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-1734
Mailing Address - Country:US
Mailing Address - Phone:330-853-1355
Mailing Address - Fax:
Practice Address - Street 1:1112 SOUTH MILL STREET
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-1112
Practice Address - Country:US
Practice Address - Phone:724-658-4564
Practice Address - Fax:724-654-9210
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist