Healthcare Provider Details

I. General information

NPI: 1417072570
Provider Name (Legal Business Name): MS. MARILYN BRANDYBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WELLS ST
WESTERLY RI
02891-2922
US

IV. Provider business mailing address

65 TUM A LUM CIR
WESTERLY RI
02891-3159
US

V. Phone/Fax

Practice location:
  • Phone: 401-348-3562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01077
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: