Provider Demographics
NPI:1053962605
Name:GRIFFITH, BRENDA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:GRIFFITH
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:EAGLE PASS COURT 18
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE
Mailing Address - State:NE
Mailing Address - Zip Code:69144
Mailing Address - Country:US
Mailing Address - Phone:308-280-0494
Mailing Address - Fax:
Practice Address - Street 1:EAGLE PASS COURT 18
Practice Address - Street 2:
Practice Address - City:KEYSTONE
Practice Address - State:NE
Practice Address - Zip Code:69144
Practice Address - Country:US
Practice Address - Phone:308-280-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist