MEDICARE: MS. BRENDA HERNANDEZ MASSAGETHERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	9479	CO

General Provider Information

NPI Number	:	1538447826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA HERNANDEZ MASSAGETHERAPIST

Provider Business Mailing Address
First Line	:	3470 S SHERMAN ST STE 1
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2663
Country	:	US
Telephone Number	:	720-289-5414
Fax Number	:

Provider Business Practice Location Address
First Line	:	3470 S SHERMAN ST STE 1
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-2663
Country	:	US
Telephone Number	:	720-289-5414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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