Provider Demographics
NPI:1013981273
Name:BRENNAN, MELANIE DAWN (DPT)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DAWN
Last Name:BRENNAN
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:PO BOX 7465
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55903-7465
Mailing Address - Country:US
Mailing Address - Phone:507-259-7574
Mailing Address - Fax:888-624-3107
Practice Address - Street 1:5335 E FRONTAGE RD NW
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-5931
Practice Address - Country:US
Practice Address - Phone:507-259-7570
Practice Address - Fax:888-624-3107
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN270958000Medicaid
MN650001987Medicare PIN
MN650023634Medicare ID - Type UnspecifiedRAILROAD
MN650000788Medicare PIN