Provider Demographics
NPI:1629632385
Name:BRENNEMAN, CODY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BRENNEMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:BRENNEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3560 PA-309
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069
Mailing Address - Country:US
Mailing Address - Phone:484-426-2005
Mailing Address - Fax:610-366-8508
Practice Address - Street 1:3560 PA-309
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069
Practice Address - Country:US
Practice Address - Phone:484-426-2005
Practice Address - Fax:610-366-8508
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist