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General NPI Number Information
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NPI Number | 1144837832
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Entity Type | Individual
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Provider Name | RAESHELL BROD LMT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2020
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 1523 RUNAWAY BAY DR APT 2C
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City | COLUMBUS
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State | OH
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Zip | 43204-4810
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Country | US
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Telephone | 614-843-4917
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 RUNAWAY BAY DR APT 2C
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City | COLUMBUS
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State | OH
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Zip | 43204-4810
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Country | US
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Telephone | 614-843-4917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33-024982
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License Number State | OH
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