Provider Demographics
NPI:1326249764
Name:BRENNAN, LISANE M (PT)
Entity Type:Individual
Prefix:MS
First Name:LISANE
Middle Name:M
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5500 KNOLL NORTH DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2209
Mailing Address - Country:US
Mailing Address - Phone:410-964-9650
Mailing Address - Fax:410-964-9653
Practice Address - Street 1:5500 KNOLL NORTH DR
Practice Address - Street 2:SUITE 230
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2209
Practice Address - Country:US
Practice Address - Phone:410-964-9650
Practice Address - Fax:410-964-9653
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT-5964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist