Provider Demographics
NPI:1639475262
Name:BRANDLAND, SHIRLEY ANN (LCMT)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:BRANDLAND
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16418 LEDGE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3506
Mailing Address - Country:US
Mailing Address - Phone:720-350-1805
Mailing Address - Fax:
Practice Address - Street 1:19557 E MAINSTREET
Practice Address - Street 2:SUITE 111
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7393
Practice Address - Country:US
Practice Address - Phone:720-350-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6590225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist