Provider Demographics
NPI:1134101082
Name:RODE, BRENDA RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:RENEE
Last Name:RODE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 NW YORK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-9701
Mailing Address - Country:US
Mailing Address - Phone:541-797-6104
Mailing Address - Fax:541-797-6106
Practice Address - Street 1:633 NW YORK DR STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-9701
Practice Address - Country:US
Practice Address - Phone:541-797-6104
Practice Address - Fax:541-797-6106
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR156391Medicare PIN