Individual
BRANDON BROMBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
901 GAYFER AVE APT 1314, FAIRHOPE, AL 36532-3906
(251) 895-4187
Mailing address
901 GAYFER AVE APT 1314, FAIRHOPE, AL 36532-3906
(251) 895-4187
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4890
AL
Other
Enumeration date
11/13/2017
Last updated
11/13/2017
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