Provider Demographics
NPI:1407458664
Name:BRENNAN, PATRICIA LOU
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOU
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28100 TORCH PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4030
Mailing Address - Country:US
Mailing Address - Phone:630-413-5800
Mailing Address - Fax:
Practice Address - Street 1:133 LAURELBROOKE DR
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2653
Practice Address - Country:US
Practice Address - Phone:814-849-3615
Practice Address - Fax:814-849-0793
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000782225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant