Provider Demographics
NPI:1831398262
Name:FORD, BRENDA ELAINE (PTA)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ELAINE
Last Name:FORD
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:W5585 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:TREGO
Mailing Address - State:WI
Mailing Address - Zip Code:54888-9422
Mailing Address - Country:US
Mailing Address - Phone:218-260-0306
Mailing Address - Fax:
Practice Address - Street 1:W5585 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:TREGO
Practice Address - State:WI
Practice Address - Zip Code:54888-9422
Practice Address - Country:US
Practice Address - Phone:218-260-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant