Provider Demographics
NPI:1154679579
Name:BRENDEN, JESSICA LAURANN (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAURANN
Last Name:BRENDEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 CHERYL ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4229
Mailing Address - Country:US
Mailing Address - Phone:406-671-9218
Mailing Address - Fax:
Practice Address - Street 1:1527 CHERYL ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4229
Practice Address - Country:US
Practice Address - Phone:406-671-9218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant