Provider Demographics
NPI:1396001400
Name:HUCK, BRENDA SUE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:HUCK
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 1:11141 STATE ROUTE 676
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5476
Mailing Address - Country:US
Mailing Address - Phone:740-749-3379
Mailing Address - Fax:
Practice Address - Street 1:11141 STATE ROUTE 676
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-5476
Practice Address - Country:US
Practice Address - Phone:740-749-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA001413225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant