Provider Demographics
NPI:1871879569
Name:DAVIS, BRANDI LETITICA (CMT)
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:LETITICA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:LETITICA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:227 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-3013
Mailing Address - Country:US
Mailing Address - Phone:276-759-6900
Mailing Address - Fax:
Practice Address - Street 1:227 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-3013
Practice Address - Country:US
Practice Address - Phone:276-759-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006856225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist