Provider Demographics
NPI:1558590935
Name:BIVENS, BRENDA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:BIVENS
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 1:302 W G ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7076
Mailing Address - Country:US
Mailing Address - Phone:402-461-9501
Mailing Address - Fax:402-462-2668
Practice Address - Street 1:2307 OSBORNE DRIVE WEST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-462-2665
Practice Address - Fax:402-462-2668
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist