Healthcare Provider Details

I. General information

NPI: 1609091255
Provider Name (Legal Business Name): HANNAH FAITH BRENNAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY
AVON IN
46123-7085
US

IV. Provider business mailing address

778 COURTNEY CIR
DANVILLE IN
46122-2703
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-3000
  • Fax:
Mailing address:
  • Phone: 317-402-2759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003215A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: