Provider Demographics
NPI:1154690063
Name:BRENNER, JILL F (PT, DPT, ATC, OCS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:F
Last Name:BRENNER
Suffix:
Gender:F
Credentials:PT, DPT, ATC, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-3354
Mailing Address - Country:US
Mailing Address - Phone:415-391-9686
Mailing Address - Fax:415-352-5089
Practice Address - Street 1:728 PACIFIC AVENUE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-3354
Practice Address - Country:US
Practice Address - Phone:415-433-3318
Practice Address - Fax:415-433-3358
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871255225100000X
CA40094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist