Provider Demographics
NPI:1952778995
Name:DAWSON, BRENDA ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELLEN
Last Name:DAWSON
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 1:1755 TOWN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7970
Mailing Address - Country:US
Mailing Address - Phone:330-896-7500
Mailing Address - Fax:
Practice Address - Street 1:1755 TOWN PARK BLVD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7970
Practice Address - Country:US
Practice Address - Phone:330-896-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist