Provider Demographics
NPI:1255409454
Name:SUDENC, BRIGETTE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:MARIE
Last Name:SUDENC
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 1:259 MOUNTS BAY CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779
Mailing Address - Country:US
Mailing Address - Phone:407-230-3636
Mailing Address - Fax:
Practice Address - Street 1:2711 STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779
Practice Address - Country:US
Practice Address - Phone:407-774-3311
Practice Address - Fax:407-774-4146
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43812225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist