Provider Demographics
NPI:1871779041
Name:MILBRATH, BRENDA D (PT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:D
Last Name:MILBRATH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 S QUAM DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3157
Mailing Address - Country:US
Mailing Address - Phone:608-873-0944
Mailing Address - Fax:
Practice Address - Street 1:1861 S QUAM DR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-3157
Practice Address - Country:US
Practice Address - Phone:608-873-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4210-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist