Provider Demographics
NPI:1750623195
Name:MARTIN, BRANDE S (LMT)
Entity type:Individual
Prefix:
First Name:BRANDE
Middle Name:S
Last Name:MARTIN
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 1:2360 WEST JOPPA ROAD
Mailing Address - Street 2:JOPPA CONCOURSE, SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-828-3585
Mailing Address - Fax:410-321-1084
Practice Address - Street 1:2360 WEST JOPPA ROAD
Practice Address - Street 2:JOPPA CONCOURSE, SUITE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-828-3585
Practice Address - Fax:410-321-1084
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2013-03-25
Deactivation Date:2013-02-27
Deactivation Code:
Reactivation Date:2013-03-25
Provider Licenses
StateLicense IDTaxonomies
MDM03956225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist