Provider Demographics
NPI:1790972826
Name:BARKELOO, BRENDA SUE (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:BARKELOO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58975 WILCOX RD
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-9749
Mailing Address - Country:US
Mailing Address - Phone:740-338-1516
Mailing Address - Fax:
Practice Address - Street 1:58975 WILCOX RD
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-9749
Practice Address - Country:US
Practice Address - Phone:740-338-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist