Provider Demographics
NPI:1437598646
Name:WOLFE-BROBERG, BRENDA E (LPTA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:WOLFE-BROBERG
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-0846
Mailing Address - Country:US
Mailing Address - Phone:207-240-8931
Mailing Address - Fax:
Practice Address - Street 1:51 STACKPOLE DR
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-7000
Practice Address - Country:US
Practice Address - Phone:207-255-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3236225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant