Healthcare Provider Details

I. General information

NPI: 1437670494
Provider Name (Legal Business Name): JON BRENNAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 NATIONAL AVE STE 203
LOS GATOS CA
95032-2400
US

IV. Provider business mailing address

1001 E EVELYN TER APT 161
SUNNYVALE CA
94086-6791
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-1990
  • Fax: 408-356-4736
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number293079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: