Provider Demographics
NPI:1043011851
Name:BROWN OBRANTY, BIANCA TIAMERA (LMT)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:TIAMERA
Last Name:BROWN OBRANTY
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:TIAMERA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:83 GENEVA DR STE 620224
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6777
Mailing Address - Country:US
Mailing Address - Phone:407-504-9757
Mailing Address - Fax:
Practice Address - Street 1:1803 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8597
Practice Address - Country:US
Practice Address - Phone:407-504-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA105928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist