Provider Demographics
NPI:1982919932
Name:CASTINE, BRENDA LOIS (LMP, LMT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOIS
Last Name:CASTINE
Suffix:
Gender:F
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13011 NE PINEBROOK ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-0853
Mailing Address - Country:US
Mailing Address - Phone:360-831-1936
Mailing Address - Fax:
Practice Address - Street 1:11818 SE MILL PLAIN BLVD STE 311B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5091
Practice Address - Country:US
Practice Address - Phone:360-831-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60133714225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist