Provider Demographics
NPI:1699922310
Name:BRENNAN, KATHERINE ANN (DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E WINDING LANE CT
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-8774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1410 N WOODLAWN BLVD STE E
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2954
Practice Address - Country:US
Practice Address - Phone:316-788-1566
Practice Address - Fax:316-788-1754
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist