Healthcare Provider Details

I. General information

NPI: 1780149567
Provider Name (Legal Business Name): BRANDY TEP LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 09/29/2026
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 S 47TH ST STE 104
TACOMA WA
98409-4427
US

IV. Provider business mailing address

3516 S 47TH ST STE 104
TACOMA WA
98409
US

V. Phone/Fax

Practice location:
  • Phone: 253-345-1151
  • Fax:
Mailing address:
  • Phone: 253-345-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60762157
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: