Healthcare Provider Details

I. General information

NPI: 1124806385
Provider Name (Legal Business Name): POLLYANN BRANDMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E. ST. LOUIS ST/
SPRINGFIELD MO
65806
US

IV. Provider business mailing address

1034 E. MCGEE ST.
SPRINGFIELD MO
65807
US

V. Phone/Fax

Practice location:
  • Phone: 417-894-8757
  • Fax:
Mailing address:
  • Phone: 417-894-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2002027061
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: