Provider Demographics
NPI:1275005399
Name:BRENNAN, ROBERT JAMES (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-3311
Mailing Address - Country:US
Mailing Address - Phone:215-360-8593
Mailing Address - Fax:
Practice Address - Street 1:1460 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-5195
Practice Address - Country:US
Practice Address - Phone:540-542-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0072352255A2300X
FL52552255A2300X
VA01260033762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer