Provider Demographics
NPI:1811208929
Name:REYNOLDS, BRENDA KH (NCMT, CMT, LMT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KH
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:NCMT, CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:400 TAMI DR E
Mailing Address - City:SUPERIOR
Mailing Address - State:MT
Mailing Address - Zip Code:59872-0523
Mailing Address - Country:US
Mailing Address - Phone:406-822-3278
Mailing Address - Fax:406-822-3278
Practice Address - Street 1:400 TAMI DR E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872
Practice Address - Country:US
Practice Address - Phone:406-544-1262
Practice Address - Fax:406-822-3278
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT433225700000X
MTC189163225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist