Provider Demographics
NPI:1912247594
Name:BALL, BRANDAIS FAYE
Entity Type:Individual
Prefix:
First Name:BRANDAIS
Middle Name:FAYE
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 CENTER ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2314
Mailing Address - Country:US
Mailing Address - Phone:253-476-0449
Mailing Address - Fax:253-476-0286
Practice Address - Street 1:5006 CENTER ST
Practice Address - Street 2:SUITE N
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2314
Practice Address - Country:US
Practice Address - Phone:253-476-0449
Practice Address - Fax:253-476-0286
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60282022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 60282022OtherMASSAGE PRACTITIONER LICENSE