MEDICARE: BETHANY ANN BLAHNIK BRENNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT.012508	OH

General Provider Information

NPI Number	:	1336092261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ANN BLAHNIK BRENNAN

Provider Business Mailing Address
First Line	:	730 SOM CENTER RD STE 330
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2362
Country	:	US
Telephone Number	:	440-684-1833
Fax Number	:	440-684-1856

Provider Business Practice Location Address
First Line	:	730 SOM CENTER RD STE 330
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2362
Country	:	US
Telephone Number	:	440-684-1833
Fax Number	:	440-684-1856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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