Provider Demographics
NPI:1063140473
Name:BRANDO, ERIN (LMT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BRANDO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:KEHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:9707 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9581
Mailing Address - Country:US
Mailing Address - Phone:443-862-4956
Mailing Address - Fax:
Practice Address - Street 1:1 N HAVEN ST STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-1614
Practice Address - Country:US
Practice Address - Phone:443-862-4956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist