Provider Demographics
NPI:1851562979
Name:BRENNEMAN, CAMERON (DPT)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:BRENNEMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PITKIN AVE # 101
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7805
Mailing Address - Country:US
Mailing Address - Phone:949-933-7516
Mailing Address - Fax:
Practice Address - Street 1:215 PITKIN AVE # 101
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7805
Practice Address - Country:US
Practice Address - Phone:949-933-7516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist