Provider Demographics
NPI:1952560286
Name:BLEVINS, BRENDA ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ANN
Last Name:BLEVINS
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 1:1022 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9662
Mailing Address - Country:US
Mailing Address - Phone:660-238-2039
Mailing Address - Fax:
Practice Address - Street 1:1485 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE2051
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-5303
Practice Address - Country:US
Practice Address - Phone:800-798-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116813225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant