MEDICARE: BRANDI ELIZABETH RYAN LMT

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	022353	NY

General Provider Information

NPI Number	:	1962645432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI ELIZABETH RYAN LMT

Provider Business Mailing Address
First Line	:	4720 SWEETFERN ROW
Second Line	:	APT 106
City	:	WILMINGTON
State	:	NC
Zip	:	28411
Country	:	US
Telephone Number	:	585-802-0368
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 SWEETFERN ROW APT 106
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28411-6020
Country	:	US
Telephone Number	:	585-802-0368
Fax Number	:

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	06/12/2026

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