Provider Demographics
NPI:1568635035
Name:OEHLERICH, BRENDA SUE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:OEHLERICH
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 1:115 W BROAD ST
Mailing Address - Street 2:PO BOX 122
Mailing Address - City:NORTH ENGLISH
Mailing Address - State:IA
Mailing Address - Zip Code:52316
Mailing Address - Country:US
Mailing Address - Phone:319-664-6134
Mailing Address - Fax:
Practice Address - Street 1:3661 ROCHESTER AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-341-8268
Practice Address - Fax:319-341-6729
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00740225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant