Provider Demographics
NPI:1215322011
Name:PENNINGS, BRANDON MICHAEL (ATC, LAT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:PENNINGS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208-9737
Mailing Address - Country:US
Mailing Address - Phone:920-713-0702
Mailing Address - Fax:
Practice Address - Street 1:224 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208-9737
Practice Address - Country:US
Practice Address - Phone:920-713-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20000193852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer