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NPI Code Detail

MEDICARE: LEE K BRENNAN PT

MEDICARE:   LEE K 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 TherapistPTL0006404CO

General Provider Information

NPI Number : 1457358228
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEE K BRENNAN PT
Provider Business Mailing Address
First Line : PO BOX 5718
Second Line :
City : KALISPELL
State : MT
Zip : 59903-5718
Country : US
Telephone Number : 406-756-0134
Fax Number : 406-300-1612
Provider Business Practice Location Address
First Line : 2750 BROADWAY ST
Second Line :
City : BOULDER
State : CO
Zip : 80304-3573
Country : US
Telephone Number : 303-440-3034
Fax Number : 303-402-1665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 11/15/2019

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