Healthcare Provider Details

I. General information

NPI: 1053187328
Provider Name (Legal Business Name): BRITTANY SIRA LAC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY SHORT LAC, LMT

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PLANTERS RETREAT
EDISTO ISLAND SC
29438-6987
US

IV. Provider business mailing address

74 PLANTERS RETREAT
EDISTO ISLAND SC
29438-6987
US

V. Phone/Fax

Practice location:
  • Phone: 854-844-3251
  • Fax:
Mailing address:
  • Phone: 854-844-3251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.022658
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000372
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number404
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: