Provider Demographics
NPI:1154395911
Name:PORTER-POLICOFF, BRENDA LYNN (ATC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LYNN
Last Name:PORTER-POLICOFF
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-1966
Mailing Address - Country:US
Mailing Address - Phone:740-432-9664
Mailing Address - Fax:
Practice Address - Street 1:216 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2528
Practice Address - Country:US
Practice Address - Phone:740-435-8181
Practice Address - Fax:740-435-8101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000012242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer