Provider Demographics
NPI:1932392388
Name:HARVEY, BRENDA BERNICE (PTA)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:BERNICE
Last Name:HARVEY
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:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:ALLISON
Mailing Address - State:TX
Mailing Address - Zip Code:79003-0076
Mailing Address - Country:US
Mailing Address - Phone:509-945-4868
Mailing Address - Fax:
Practice Address - Street 1:3200 MISSION ARCH DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-8307
Practice Address - Country:US
Practice Address - Phone:509-945-4868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0538225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant