Provider Demographics
NPI:1689316044
Name:GIVENS, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:GIVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3834
Mailing Address - Country:US
Mailing Address - Phone:989-401-9400
Mailing Address - Fax:
Practice Address - Street 1:2504 BLAKE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3834
Practice Address - Country:US
Practice Address - Phone:989-401-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist