Provider Demographics
NPI:1932200268
Name:SCANTLING, BRENDA SUE (PT MS)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:SCANTLING
Suffix:
Gender:F
Credentials:PT MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:BONNEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-0341
Mailing Address - Country:US
Mailing Address - Phone:479-675-4918
Mailing Address - Fax:479-474-4044
Practice Address - Street 1:4505 NORTH RUDY ROAD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-9062
Practice Address - Country:US
Practice Address - Phone:479-474-4011
Practice Address - Fax:479-474-4044
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5T191OtherBLUE CROSS BLUE SHIELD