Provider Demographics
NPI:1508471145
Name:BRENTS, MICHAEL CLELLAND (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLELLAND
Last Name:BRENTS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7202 WILLIAMSGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7017
Mailing Address - Country:US
Mailing Address - Phone:502-689-6557
Mailing Address - Fax:
Practice Address - Street 1:190 W 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2264
Practice Address - Country:US
Practice Address - Phone:270-789-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist