Provider Demographics
NPI:1992918437
Name:ROUNDY, BRENDA (LMP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:ROUNDY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:TAYLOR
Other - Last Name:ROUNDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:8008 N. MAPLE ST.
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208
Mailing Address - Country:US
Mailing Address - Phone:509-465-4793
Mailing Address - Fax:
Practice Address - Street 1:101 W. 8TH AVE.
Practice Address - Street 2:STE. 1300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99220
Practice Address - Country:US
Practice Address - Phone:509-474-4084
Practice Address - Fax:509-474-3129
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020369172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist