Provider Demographics
NPI:1871325654
Name:BIFFLE, BRENDAN KEITH (PTA)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:KEITH
Last Name:BIFFLE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 NS 3530
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-5869
Mailing Address - Country:US
Mailing Address - Phone:405-380-3017
Mailing Address - Fax:
Practice Address - Street 1:20926 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-6608
Practice Address - Country:US
Practice Address - Phone:405-391-2300
Practice Address - Fax:405-391-2301
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3851225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant