Provider Demographics
NPI:1730587858
Name:BENDER, BREANNA LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:LEIGH
Last Name:BENDER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:LEIGH
Other - Last Name:UETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:217 E BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3435
Mailing Address - Country:US
Mailing Address - Phone:319-352-4544
Mailing Address - Fax:319-352-4655
Practice Address - Street 1:3 RUSSELL SLADE BLVD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2667
Practice Address - Country:US
Practice Address - Phone:319-930-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-06
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist