Provider Demographics
NPI:1386471357
Name:MASON, BRANDI KATHRYN (MT)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:KATHRYN
Last Name:MASON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 S CARSON ST UNIT 205
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-7125
Mailing Address - Country:US
Mailing Address - Phone:303-653-4967
Mailing Address - Fax:
Practice Address - Street 1:3912 S CARSON ST UNIT 205
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-7125
Practice Address - Country:US
Practice Address - Phone:303-653-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0011690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist