Provider Demographics
NPI:1124428255
Name:TAINSH, BRENNA
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:TAINSH
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 1:765 ALLENS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5443
Mailing Address - Country:US
Mailing Address - Phone:401-432-6800
Mailing Address - Fax:401-432-6832
Practice Address - Street 1:765 ALLENS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-5443
Practice Address - Country:US
Practice Address - Phone:401-432-6800
Practice Address - Fax:401-432-6832
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02709225100000X
MA21508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist