Healthcare Provider Details

I. General information

NPI: 1073110466
Provider Name (Legal Business Name): BRENDEN KUHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAKE BALDWIN LN APT B
ORLANDO FL
32814-6665
US

IV. Provider business mailing address

1107 LAKE BALDWIN LN UNIT 106
ORLANDO FL
32814-6814
US

V. Phone/Fax

Practice location:
  • Phone: 407-304-9558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: