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General NPI Number Information
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NPI Number | 1568928208
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Entity Type | Individual
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Provider Name | BRANDI NACHOLE RUNYON LMT
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Gender | Female
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 183 E 2ND AVE
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City | WILLIAMSON
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State | WV
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Zip | 25661-3601
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Country | US
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Telephone | 304-928-3018
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Fax |
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Provider Business Mailing Address
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Address Line | 767 DANS BRANCH RD
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City | WILLIAMSON
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State | WV
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Zip | 25661-9122
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Country | US
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Telephone | 304-235-2574
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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 | 2009-2556
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License Number State | WV
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