Provider Demographics
NPI:1790728442
Name:BRUMMEL, DENISE L (RPT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:L
Last Name:BRUMMEL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 FAIRGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1638
Mailing Address - Country:US
Mailing Address - Phone:660-584-7801
Mailing Address - Fax:660-584-8619
Practice Address - Street 1:720 FAIRGROUND AVENUE
Practice Address - Street 2:PHYSICAL THERAPY OF HIGGINSVILLE
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037
Practice Address - Country:US
Practice Address - Phone:660-584-7801
Practice Address - Fax:660-584-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO33516029OtherBCBSKC
MOR21C753Medicare PIN