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General NPI Number Information
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NPI Number | 1184344673
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Entity Type | Individual
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Provider Name | BRANDI EVE COLLESIDES LMT
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Gender | Female
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 2 ROSELL DR
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City | BALLSTON LAKE
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State | NY
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Zip | 12019-1433
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Country | US
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Telephone | 518-663-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 45 CHERYL CT
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City | TROY
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State | NY
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Zip | 12180-7023
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Country | US
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Telephone | 518-322-9550
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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 | 017444
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License Number State | NY
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