Provider Demographics
NPI:1770106098
Name:MCNULTY, BRENDAN FREEMAN (DPT)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:FREEMAN
Last Name:MCNULTY
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 1:1220 CROZET AVE
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3163
Mailing Address - Country:US
Mailing Address - Phone:434-823-4307
Mailing Address - Fax:
Practice Address - Street 1:1220 CROZET AVE
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3163
Practice Address - Country:US
Practice Address - Phone:434-823-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist