Provider Demographics
NPI:1952607186
Name:HARTEAU, BRANDY RAE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:RAE
Last Name:HARTEAU
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 1:2748 MILTON WAY STE 211
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9379
Mailing Address - Country:US
Mailing Address - Phone:253-952-0302
Mailing Address - Fax:253-952-0307
Practice Address - Street 1:2748 MILTON WAY STE 211
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9379
Practice Address - Country:US
Practice Address - Phone:253-952-0302
Practice Address - Fax:253-952-0307
Is Sole Proprietor?:No
Enumeration Date:2011-02-05
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60204140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist