MEDICARE: MS. ANNE THERESA MCGOWAN BRESNAHAN 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	208100000X	Physical Medicine & Rehabilitation Physician	006194	NY

General Provider Information

NPI Number	:	1487703179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE THERESA MCGOWAN BRESNAHAN PT

Provider Business Mailing Address
First Line	:	25 QUEENS WALK
Second Line	:
City	:	BREEZY POINT
State	:	NY
Zip	:	11697-1611
Country	:	US
Telephone Number	:	508-494-9657
Fax Number	:	718-474-5579

Provider Business Practice Location Address
First Line	:	25 QUEENS WALK
Second Line	:
City	:	BREEZY POINT
State	:	NY
Zip	:	11697-1611
Country	:	US
Telephone Number	:	508-494-9657
Fax Number	:	978-692-8840

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	12/04/2023

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