Provider Demographics
NPI:1063909828
Name:BRENNAN, ROBERT STEVEN JR (LMT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEVEN
Last Name:BRENNAN
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 W WINDY LN
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-5676
Mailing Address - Country:US
Mailing Address - Phone:509-205-5931
Mailing Address - Fax:
Practice Address - Street 1:10121 W CLEARWATER AVE STE 112
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3500
Practice Address - Country:US
Practice Address - Phone:509-948-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60668331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist