MEDICARE: EILEEN BRENNAN 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	4324	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4324	OTHER	MT	STATE LICENSE

General Provider Information

NPI Number	:	1689935710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN BRENNAN PT

Provider Business Mailing Address
First Line	:	3180 DREDGE DR STE F
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59602-0561
Country	:	US
Telephone Number	:	406-449-0654
Fax Number	:	406-449-0516

Provider Business Practice Location Address
First Line	:	3180 DREDGE DR STE F
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59602-0561
Country	:	US
Telephone Number	:	406-449-0654
Fax Number	:	406-449-0516

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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Directions to “ EILEEN BRENNAN PT” Practice Location

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