Provider Demographics
NPI:1578621629
Name:MCDONOUGH, BRENDAN MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:MICHAEL
Last Name:MCDONOUGH
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 1:1930 MARLTON PIKE E
Mailing Address - Street 2:SUITE E27
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-424-6677
Mailing Address - Fax:856-489-1803
Practice Address - Street 1:1930 MARLTON PIKE E
Practice Address - Street 2:SUITE E27
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-424-6677
Practice Address - Fax:856-489-1803
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01105600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2268236000OtherAMERIHEALTH ID
NJ2268236000OtherIND BCBS PERSONAL CHOICE
NJ2268236000OtherIND BCBS PERSONAL CHOICE