Provider Demographics
NPI:1821402249
Name:MEYER, BRENNA ELIZABETH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:ELIZABETH
Last Name:MEYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1127
Mailing Address - Country:US
Mailing Address - Phone:920-648-2400
Mailing Address - Fax:920-648-2444
Practice Address - Street 1:805 ELM ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1127
Practice Address - Country:US
Practice Address - Phone:920-648-2400
Practice Address - Fax:920-648-2444
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12745 - 24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist