Healthcare Provider Details

I. General information

NPI: 1750667127
Provider Name (Legal Business Name): BRANDY FRICK LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 E 57TH AVE
SPOKANE WA
99223-7040
US

IV. Provider business mailing address

2915 N ELLA RD
SPOKANE VALLEY WA
99212-2120
US

V. Phone/Fax

Practice location:
  • Phone: 509-448-9398
  • Fax:
Mailing address:
  • Phone: 509-954-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60247233
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: