Healthcare Provider Details

I. General information

NPI: 1962645432
Provider Name (Legal Business Name): BRANDI ELIZABETH RYAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 SWEETFERN ROW APT 106
WILMINGTON NC
28411-6020
US

IV. Provider business mailing address

4720 SWEETFERN ROW APT 106
WILMINGTON NC
28411
US

V. Phone/Fax

Practice location:
  • Phone: 585-802-0368
  • Fax:
Mailing address:
  • Phone: 585-802-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number022353
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: