Provider Demographics
NPI:1801328513
Name:BRENDA BROWN RN LMT LLC
Entity type:Organization
Organization Name:BRENDA BROWN RN LMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:614-579-0356
Mailing Address - Street 1:2700 E MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2536
Mailing Address - Country:US
Mailing Address - Phone:614-579-0356
Mailing Address - Fax:
Practice Address - Street 1:2700 E MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2536
Practice Address - Country:US
Practice Address - Phone:614-579-0356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRENDA BROWN RN LMT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.006980302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH820875480OtherHEALTHCARE ACCOUNTS FROM ORGANIZATIONS THAT PROVIDE MASSAGE