Provider Demographics
NPI:1184344673
Name:COLLESIDES, BRANDI EVE (LMT)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:EVE
Last Name:COLLESIDES
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 1:45 CHERYL CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7023
Mailing Address - Country:US
Mailing Address - Phone:518-322-9550
Mailing Address - Fax:
Practice Address - Street 1:2 ROSELL DR
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1433
Practice Address - Country:US
Practice Address - Phone:518-663-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist