Provider Demographics
NPI:1841519303
Name:STUBITSCH, BRENDA ANN (PT, BSPT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:STUBITSCH
Suffix:
Gender:F
Credentials:PT, BSPT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, BSPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:678 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1653
Practice Address - Country:US
Practice Address - Phone:816-380-3325
Practice Address - Fax:816-380-3044
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005743225100000X
MO2018034945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS
IL140158Medicare PIN