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General NPI Number Information
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NPI Number | 1457530214
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Entity Type | Individual
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Provider Name | DIANNE MARY BRENNAN P.T.
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Gender | Female
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 100 W GORE ST
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City | ORLANDO
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State | FL
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Zip | 32806-1044
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Country | US
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Telephone | 407-835-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 13562 OLD DOCK RD
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City | ORLANDO
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State | FL
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Zip | 32828-6198
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Country | US
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Telephone | 407-243-2395
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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 | PT23224
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License Number State | FL
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