Provider Demographics
NPI:1588438691
Name:DUNN, BRENDA ELIZABETH (LMT)
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:ELIZABETH
Last Name:DUNN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 AVENIDA CUARTA APT 108
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-7091
Mailing Address - Country:US
Mailing Address - Phone:863-521-0421
Mailing Address - Fax:
Practice Address - Street 1:602 AVENIDA CUARTA APT 108
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7091
Practice Address - Country:US
Practice Address - Phone:863-521-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66512225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist