Provider Demographics
NPI:1619315751
Name:HILL, BRENNA ELIZABETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:ELIZABETH
Last Name:HILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6942 E 3500N RD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4054
Mailing Address - Country:US
Mailing Address - Phone:815-263-9852
Mailing Address - Fax:
Practice Address - Street 1:6942 E 3500N RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4054
Practice Address - Country:US
Practice Address - Phone:815-263-9852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160005675283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital