Provider Demographics
NPI:1477038156
Name:MCGREEVY, BRENDAN (DPT)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:MCGREEVY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W MAIN ST APT 419
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3548
Mailing Address - Country:US
Mailing Address - Phone:813-451-3585
Mailing Address - Fax:
Practice Address - Street 1:330 WESTERN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4383
Practice Address - Country:US
Practice Address - Phone:860-657-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist