Healthcare Provider Details

I. General information

NPI: 1891305140
Provider Name (Legal Business Name): BRENDAN CALEB COFFEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S 84TH ST STE 150
MILWAUKEE WI
53214-1481
US

IV. Provider business mailing address

670 RHODE ISLAND AVE NE APT 509A
WASHINGTON DC
20002-1499
US

V. Phone/Fax

Practice location:
  • Phone: 414-455-9500
  • Fax:
Mailing address:
  • Phone: 785-312-1732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2000046
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3057-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: