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General NPI Number Information
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NPI Number | 1740149566
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Entity Type | Individual
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Provider Name | MARIETTA BRADY LMT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2026
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Last Update Date | 01/17/2026
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Provider Practice Location Address
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Address Line | 755 E 2ND AVE STE D
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City | DURANGO
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State | CO
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Zip | 81301-5472
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Country | US
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Telephone | 928-890-8338
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Fax |
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Provider Business Mailing Address
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Address Line | 810 WATERFALL LN
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City | DURANGO
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State | CO
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Zip | 81301-3761
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Country | US
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Telephone | 928-890-8338
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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 | MT.0026080
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License Number State | CO
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