Individual
DERRICK MICHAEL BRANTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
572 HAMILTON AVE, ORANGE CITY, FL 32763-4610
(386) 801-0642
Mailing address
572 HAMILTON AVE, ORANGE CITY, FL 32763-4610
(386) 801-0642
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
79136
FL
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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