Individual
BRENT G BINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5525 N 19TH ST, PHOENIX, AZ 85016-3004
(928) 961-4837
Mailing address
5525 N 19TH ST, PHOENIX, AZ 85016-3004
(928) 961-4837
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
6735789-4701
UT
225700000X
Massage Therapist
Primary
MT00834
AZ
Other
Enumeration date
06/17/2008
Last updated
02/18/2014
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