Provider Demographics
NPI:1922189992
Name:BRENNAN, JAMES M (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 OLD CHURCHMANS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2143
Mailing Address - Country:US
Mailing Address - Phone:302-366-7600
Mailing Address - Fax:610-601-4416
Practice Address - Street 1:1082 OLD CHURCHMANS RD STE 101
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2143
Practice Address - Country:US
Practice Address - Phone:302-366-7600
Practice Address - Fax:610-601-4416
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
J10000806225100000X
MI5501011621225100000X
NJ40QA01198700225100000X
PAPT007239L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01378W01Medicare PIN