Individual
BRENDA SISTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2114 NW 40TH TER, SUITE C-4, GAINESVILLE, FL 32605-3593
(352) 262-6529
Mailing address
3738 SW 96TH ST, GAINESVILLE, FL 32608-8604
(352) 262-6529
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA51232
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C6957
BCBS
FL
Enumeration date
10/22/2008
Last updated
09/02/2011
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