Provider Demographics
NPI:1033664388
Name:BRENNEMAN, STACIA (PT)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 S SANTA FE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4162
Mailing Address - Country:US
Mailing Address - Phone:785-825-2400
Mailing Address - Fax:785-825-2403
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-452-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist