Provider Demographics
NPI:1558760686
Name:BRUMLEY, CLOTEAL (PTA)
Entity Type:Individual
Prefix:
First Name:CLOTEAL
Middle Name:
Last Name:BRUMLEY
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 1:7047 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3001
Mailing Address - Country:US
Mailing Address - Phone:810-210-2231
Mailing Address - Fax:614-604-8692
Practice Address - Street 1:7047 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3001
Practice Address - Country:US
Practice Address - Phone:810-210-2231
Practice Address - Fax:614-604-8692
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05623225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant