Provider Demographics
NPI:1780702688
Name:EDINGER, BRANDI L (LMP)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:EDINGER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1453
Mailing Address - Street 2:
Mailing Address - City:ALLYN
Mailing Address - State:WA
Mailing Address - Zip Code:98524
Mailing Address - Country:US
Mailing Address - Phone:360-801-5011
Mailing Address - Fax:360-208-0662
Practice Address - Street 1:9951 MICKELBERRY RD NW STE 215
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8309
Practice Address - Country:US
Practice Address - Phone:360-801-5011
Practice Address - Fax:360-208-0662
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist