Provider Demographics
NPI:1992227367
Name:EMERY, BRENDA (CPRP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:EMERY
Suffix:
Gender:F
Credentials:CPRP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3953
Mailing Address - Country:US
Mailing Address - Phone:208-524-5607
Mailing Address - Fax:208-535-0942
Practice Address - Street 1:540 3RD STREET
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-524-5607
Practice Address - Fax:208-535-0942
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator