Provider Demographics
NPI:1841543501
Name:PADUGANAN, BRIANNA CHARLES (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:CHARLES
Last Name:PADUGANAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 COUNTY ROAD 61
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-2562
Mailing Address - Country:US
Mailing Address - Phone:256-627-1724
Mailing Address - Fax:
Practice Address - Street 1:705 CREST ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6123
Practice Address - Country:US
Practice Address - Phone:256-627-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2454225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist