Provider Demographics
NPI:1891569323
Name:ELDRIDGE, BRENNAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LEANNA CRES
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9600
Mailing Address - Country:US
Mailing Address - Phone:585-943-5857
Mailing Address - Fax:
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-744-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30228225100000X
NY050694225100000X
COPTL.0020376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist