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General NPI Number Information
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NPI Number | 1295343945
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Entity Type | Individual
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Provider Name | BRENDA RAE SMITH
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Gender | Female
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 3220 S WESTERN AVE STE 1
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City | SIOUX FALLS
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State | SD
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Zip | 57105-5347
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Country | US
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Telephone | 605-691-9957
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 S WESTERN AVE LOWR LEVEL
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City | SIOUX FALLS
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State | SD
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Zip | 57105-5347
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Country | US
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Telephone | 605-777-9181
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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 | MT11702
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License Number State | SD
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