Provider Demographics
NPI:1770942542
Name:PENROD, BRANDY (PTA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:PENROD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 SW MULVANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1678
Mailing Address - Country:US
Mailing Address - Phone:785-295-8045
Mailing Address - Fax:785-295-5415
Practice Address - Street 1:634 SW MULVANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1678
Practice Address - Country:US
Practice Address - Phone:785-295-8045
Practice Address - Fax:785-295-5415
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant