Provider Demographics
NPI:1962928549
Name:ATKINSON, BRENDA HERRMANN
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:HERRMANN
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HASEL ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4506
Mailing Address - Country:US
Mailing Address - Phone:803-774-5500
Mailing Address - Fax:
Practice Address - Street 1:220 HASEL ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4506
Practice Address - Country:US
Practice Address - Phone:803-774-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics