Provider Demographics
NPI:1831466390
Name:BRENNER, AMY NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 S. MADISON ST.
Mailing Address - Street 2:
Mailing Address - City:DENVER,
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5609
Mailing Address - Country:US
Mailing Address - Phone:303-778-6071
Mailing Address - Fax:
Practice Address - Street 1:2480 S. CLERMONT ST.
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6512
Practice Address - Country:US
Practice Address - Phone:303-758-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist