Provider Demographics
NPI:1528281359
Name:GARLICK, BRENDA JANE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JANE
Last Name:GARLICK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 BASSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3844
Mailing Address - Country:US
Mailing Address - Phone:952-924-9534
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:BLUE 3
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1883282N00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No282N00000XHospitalsGeneral Acute Care Hospital