Most Relevant Information
Provider Data
| NPI Number: | 1003525890 |
| Provider Name: | BRENNA UNDERWOOD LMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | MT22207714 |
Most Important Dates
| Enumeration Date: | 11/21/2022 |
| Last Updated: | 11/21/2022 |
Provider Practice Location
101 THREE RIVERS N # 112
FORT WAYNE
IN
468021312
Practice Location Phone/Fax
| Phone: | 2607100873 |
| Fax: |
Provider Mailing Location
101 THREE RIVERS N # 112
FORT WAYNE
IN
468021312
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |