Provider Demographics
NPI:1457358228
Name:BRENNAN, LEE K (PT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:K
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LEE
Other - Middle Name:K
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-300-1612
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3573
Practice Address - Country:US
Practice Address - Phone:303-440-3034
Practice Address - Fax:303-402-1665
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0006404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6404OtherPHYSICAL THERAPY LICENSE
CO6404OtherPHYSICAL THERAPY LICENSE