Provider Demographics
NPI:1952014011
Name:KONJA, BRANT DAN (LMT - MASSAGE)
Entity Type:Individual
Prefix:
First Name:BRANT
Middle Name:DAN
Last Name:KONJA
Suffix:
Gender:M
Credentials:LMT - MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 8TH AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3243
Mailing Address - Country:US
Mailing Address - Phone:248-890-1214
Mailing Address - Fax:
Practice Address - Street 1:3945 8TH AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3243
Practice Address - Country:US
Practice Address - Phone:248-890-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist