Provider Demographics
NPI:1700255940
Name:PARHAM, BRENDA D (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:D
Last Name:PARHAM
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 1:203 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-1301
Mailing Address - Country:US
Mailing Address - Phone:706-816-2198
Mailing Address - Fax:
Practice Address - Street 1:203 CARRIAGE WAY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-1301
Practice Address - Country:US
Practice Address - Phone:706-816-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist