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NPI Code Detail

MEDICARE: SALLY A BRENNAN PT

MEDICARE: SALLY A BRENNAN PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist0004474CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080004474CT01OTHERCTBCBS
211241398OTHERCTCAQH

General Provider Information

NPI Number : 1346364437
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY A BRENNAN PT
Provider Business Mailing Address
First Line : 421 WIGWAM RD
Second Line :
City : KENSINGTON
State : CT
Zip : 06037-1703
Country : US
Telephone Number : 860-828-0758
Fax Number :
Provider Business Practice Location Address
First Line : 45 MERIDEN AVE
Second Line :
City : SOUTHINGTON
State : CT
Zip : 06489-3214
Country : US
Telephone Number : 860-378-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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Directions to “ SALLY A BRENNAN PT” Practice Location

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