Provider Demographics
NPI:1164504007
Name:OAKLEAF, BRENDA J (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:J
Last Name:OAKLEAF
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:J
Other - Last Name:KOHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1016 ORD ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4644
Mailing Address - Country:US
Mailing Address - Phone:307-414-0535
Mailing Address - Fax:
Practice Address - Street 1:1016 ORD ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4644
Practice Address - Country:US
Practice Address - Phone:307-414-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10557225100000X
IDPT-2992225100000X
MTPTP-PT-LIC-2488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40361400Medicaid
WI40361400Medicaid