Healthcare Provider Details

I. General information

NPI: 1992918437
Provider Name (Legal Business Name): BRENDA ROUNDY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA TAYLOR ROUNDY LMP

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W. 8TH AVE. STE. 1300
SPOKANE WA
99220
US

IV. Provider business mailing address

8008 N. MAPLE ST.
SPOKANE WA
99208
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-4084
  • Fax: 509-474-3129
Mailing address:
  • Phone: 509-465-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00020369
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: