Provider Demographics
NPI:1649938333
Name:BRODSKY, DEANNA TROI (LMT)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:TROI
Last Name:BRODSKY
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 1:1134 SE CENTENNIAL CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1366
Mailing Address - Country:US
Mailing Address - Phone:607-220-6926
Mailing Address - Fax:
Practice Address - Street 1:1134 SE CENTENNIAL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1366
Practice Address - Country:US
Practice Address - Phone:607-220-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029953225700000X
OR25919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist