Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 034422 | TX |
NPI | 1003053588 |
---|---|
Provider Name | Mrs. Brandy Lynn Credeur |
First Address | Austin, TX 78750-1884 |
Second Address | Austin, TX 78750-1885 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 27/11/2017 |