MEDICARE: MRS. KATRINA LYNN BRENNAN LMBT MMP

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	LMBT9964	NC

General Provider Information

NPI Number	:	1891064267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATRINA LYNN BRENNAN LMBT MMP

Provider Business Mailing Address
First Line	:	110 TRANTHAM DR
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-7115
Country	:	US
Telephone Number	:	704-960-9961
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 ROCK HILL CHURCH RD
Second Line	:	SUITE 102
City	:	CONCORD
State	:	NC
Zip	:	28027-6703
Country	:	US
Telephone Number	:	704-960-9961
Fax Number	:

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

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	12/14/2011

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