Provider Demographics
NPI:1548532369
Name:BRENNAN, PATRICK R (PT, DPT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 2ND ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2694
Mailing Address - Country:US
Mailing Address - Phone:248-546-2110
Mailing Address - Fax:
Practice Address - Street 1:110 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2694
Practice Address - Country:US
Practice Address - Phone:248-546-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist