Provider Demographics
NPI:1679906945
Name:BRENNAN, KATHRYN A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:37 ROUTE 236
Mailing Address - Street 2:SUITE #212
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 ROUTE 236
Practice Address - Street 2:SUITE #212
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:603-880-9111
Practice Address - Fax:603-880-6111
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist