Provider Demographics
NPI:1841251287
Name:MARCUM, BRENDA L (PT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:MARCUM
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 1:2240 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1239
Mailing Address - Country:US
Mailing Address - Phone:304-525-4445
Mailing Address - Fax:304-529-7449
Practice Address - Street 1:2240 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1239
Practice Address - Country:US
Practice Address - Phone:304-525-4445
Practice Address - Fax:304-529-7449
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001064Medicaid
OH2527608Medicaid
WV001720275OtherMOUNTAIN STATE BCBS
7403698OtherAETNA
P00156224OtherRR MEDICARE
WV4135811Medicare PIN