Provider Demographics
NPI:1730334095
Name:BRENNAN, MARY ANN
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 WOODVIEW DR
Mailing Address - Street 2:APT # 386
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6839
Mailing Address - Country:US
Mailing Address - Phone:734-502-0584
Mailing Address - Fax:
Practice Address - Street 1:2264 WOODVIEW DR
Practice Address - Street 2:APT # 386
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6839
Practice Address - Country:US
Practice Address - Phone:734-502-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant