Provider Demographics
NPI:1831313816
Name:BRENNER, MICHELLE LINN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LINN
Last Name:BRENNER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MEADOW GREEN LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5220
Mailing Address - Country:US
Mailing Address - Phone:423-775-7240
Mailing Address - Fax:
Practice Address - Street 1:721 BRYAN DR
Practice Address - Street 2:BOX 7813
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-6275
Practice Address - Country:US
Practice Address - Phone:423-775-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer