Provider Demographics
NPI:1457591042
Name:COLE, BRENDA MARIE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:MARIE
Last Name:COLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 S CHEHALIS ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2957
Mailing Address - Country:US
Mailing Address - Phone:360-591-1982
Mailing Address - Fax:360-532-0385
Practice Address - Street 1:104 S CHEHALIS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-2957
Practice Address - Country:US
Practice Address - Phone:360-591-1982
Practice Address - Fax:360-532-0385
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018449172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist