Provider Demographics
NPI:1578066460
Name:BRENNER, TARA LEE (PT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MINICH DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9345
Mailing Address - Country:US
Mailing Address - Phone:717-576-3221
Mailing Address - Fax:
Practice Address - Street 1:417 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-6945
Practice Address - Country:US
Practice Address - Phone:717-245-0610
Practice Address - Fax:717-245-0899
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009797L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist