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General NPI Number Information
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NPI Number | 1669923058
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Entity Type | Organization
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Legal Business Name | BRANDYWINE BODYWORK
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 1400 PHILADELPHIA PIKE
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City | WILMINGTON
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State | DE
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Zip | 19809-1856
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Country | US
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Telephone | 302-798-0801
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Fax | 302-798-3127
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Provider Business Mailing Address
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Address Line | 1400 PHILADELPHIA PIKE
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City | WILMINGTON
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State | DE
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Zip | 19809-1856
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Country | US
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Telephone | 302-798-0801
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Fax | 302-798-3127
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIMBERLY MARIE SHAHAN
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Credential | LMT
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Telephone | 302-798-0801
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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 | MT0004411
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License Number State | DE
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