Provider Demographics
NPI:1083621197
Name:DRENNAN, CAMILLE A (PT, MSPT, MPA)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:A
Last Name:DRENNAN
Suffix:
Gender:F
Credentials:PT, MSPT, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 SW RUSTIC CIR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6235
Mailing Address - Country:US
Mailing Address - Phone:772-286-3618
Mailing Address - Fax:772-286-9535
Practice Address - Street 1:835 SW RUSTIC CIR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6235
Practice Address - Country:US
Practice Address - Phone:772-286-3618
Practice Address - Fax:772-286-9535
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18834225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886424100Medicaid
FL680687296Medicaid