Provider Demographics
NPI:1851916589
Name:NAAKTGEBOREN, BRENDA (LMT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:NAAKTGEBOREN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-0293
Mailing Address - Country:US
Mailing Address - Phone:319-894-2062
Mailing Address - Fax:
Practice Address - Street 1:4215 LEWIS ACCESS ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-9502
Practice Address - Country:US
Practice Address - Phone:319-849-2062
Practice Address - Fax:319-849-2067
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist