Provider Demographics
NPI:1124010186
Name:STEIN, BRENDA CATHERINE (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:CATHERINE
Last Name:STEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2520
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:3160 8TH ST SW
Practice Address - Street 2:SUITE 1
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1023
Practice Address - Country:US
Practice Address - Phone:515-967-4580
Practice Address - Fax:515-967-4899
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23956Medicare UPIN