1487928156 NPI number — BRENDA SPRENKLE P.T.

Table of content: BRENDA SPRENKLE P.T. (NPI 1487928156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487928156 NPI number — BRENDA SPRENKLE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRENKLE
Provider First Name:
BRENDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEGNER
Provider Other First Name:
BRENDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487928156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/04/2016
NPI Reactivation Date:
08/28/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BRENDA SPRENKLE
Provider Second Line Business Mailing Address:
C/O PIKES PEAK BOCES 2883 S CIRCLE DRIVE
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80906-4112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-433-0129
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PKES PEAK BOCES
Provider Second Line Business Practice Location Address:
2883 S. CIRCLE DRIVE
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80906-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-622-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6009 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)