Provider Demographics
NPI:1770715872
Name:MINKS, BRENDA ELAINE (PT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ELAINE
Last Name:MINKS
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 1:115 SKYLINE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-3310
Mailing Address - Country:US
Mailing Address - Phone:479-967-5155
Mailing Address - Fax:
Practice Address - Street 1:115 SKYLINE DR
Practice Address - Street 2:SUITE A
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-3310
Practice Address - Country:US
Practice Address - Phone:479-967-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-22
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist