Provider Demographics
NPI:1548937436
Name:KABBASH, BRENNA (DPT)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:KABBASH
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 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:888-830-4125
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:452 US HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:NJ
Practice Address - Zip Code:07827-3045
Practice Address - Country:US
Practice Address - Phone:973-293-0010
Practice Address - Fax:973-293-0018
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051320225100000X
NJ40QA02031900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist