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General NPI Number Information
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NPI Number | 1265566152
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Entity Type | Individual
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Provider Name | PATRICK JOSEPH BRENNAN MS PT
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 545 PALISADO AVE
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City | WINDSOR
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State | CT
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Zip | 06095-2071
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Country | US
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Telephone | 860-687-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 162 BABCOCK HILL RD
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City | SOUTH WINDHAM
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State | CT
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Zip | 06266-1104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 005503
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License Number State | CT
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