MEDICARE: NICOLE BRENK PT

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	009141	CT

General Provider Information

NPI Number	:	1386913051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BRENK PT

Provider Business Mailing Address
First Line	:	9 COBBLESTONE RD
Second Line	:
City	:	BURLINGTON
State	:	CT
Zip	:	06013-2614
Country	:	US
Telephone Number	:	860-877-3720
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 MAIN ST STE A
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-2985
Country	:	US
Telephone Number	:	860-674-1824
Fax Number	:

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

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	09/14/2020

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Directions to “ NICOLE BRENK PT” Practice Location

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