Provider Demographics
NPI:1740322064
Name:BRENNAN, DEVRIE P (MSPT)
Entity type:Individual
Prefix:
First Name:DEVRIE
Middle Name:P
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1852
Mailing Address - Country:US
Mailing Address - Phone:925-631-1996
Mailing Address - Fax:
Practice Address - Street 1:220 BUSH ST
Practice Address - Street 2:SUITE 860
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3567
Practice Address - Country:US
Practice Address - Phone:415-986-4979
Practice Address - Fax:415-986-6951
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist