Provider Demographics
NPI:1699308890
Name:PURCHASE, BRENDA KAY (LMT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:PURCHASE
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 1:5300 NORTHLAND DR NE STE F
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1058
Mailing Address - Country:US
Mailing Address - Phone:616-430-8614
Mailing Address - Fax:
Practice Address - Street 1:5300 NORTHLAND DR NE STE F
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1058
Practice Address - Country:US
Practice Address - Phone:616-430-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist