Provider Demographics
NPI:1225098148
Name:COUSINEAU, BRENDAN PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:PATRICK
Last Name:COUSINEAU
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 1:13331 N 89TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7634
Mailing Address - Country:US
Mailing Address - Phone:480-694-5013
Mailing Address - Fax:
Practice Address - Street 1:10900 N SCOTTSDALE RD STE 205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5228
Practice Address - Country:US
Practice Address - Phone:480-694-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ115152Medicare PIN