Healthcare Provider Details

I. General information

NPI: 1750428777
Provider Name (Legal Business Name): GLORIA JEAN BARANY LMT NCTMB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52303 EMMONS RD STE 25
SOUTH BEND IN
46637-4288
US

IV. Provider business mailing address

52303 EMMONS RD STE 25
SOUTH BEND IN
46637-4288
US

V. Phone/Fax

Practice location:
  • Phone: 574-277-2323
  • Fax: 574-277-2323
Mailing address:
  • Phone: 574-277-2323
  • Fax: 574-277-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA31544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: