Provider Demographics
NPI:1194323006
Name:HAMANN, BRENTON (PT)
Entity type:Individual
Prefix:
First Name:BRENTON
Middle Name:
Last Name:HAMANN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21321 E OCOTILLO RD STE I122
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7591
Mailing Address - Country:US
Mailing Address - Phone:480-987-1870
Mailing Address - Fax:480-987-9289
Practice Address - Street 1:21321 E OCOTILLO RD STE I122
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7591
Practice Address - Country:US
Practice Address - Phone:480-987-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31397208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation