Healthcare Provider Details

I. General information

NPI: 1962421123
Provider Name (Legal Business Name): LAURIE BETH BRENNER MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LINWOOD AVE STE 2
WHITINSVILLE MA
01588-2068
US

IV. Provider business mailing address

670 LINWOOD AVE STE 2
WHITINSVILLE MA
01588-2068
US

V. Phone/Fax

Practice location:
  • Phone: 508-234-7544
  • Fax: 508-234-8002
Mailing address:
  • Phone: 508-791-8740
  • Fax: 508-752-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1307
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16784
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: