1891835336 NPI number — SHAWN P BRENNAN P.T.

Table of content: SHAWN P BRENNAN P.T. (NPI 1891835336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891835336 NPI number — SHAWN P BRENNAN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNAN
Provider First Name:
SHAWN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891835336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20372
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02920-0944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-785-1016
Provider Business Mailing Address Fax Number:
401-785-1018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 KINGSTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
NARRAGANSETT
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02882-3262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-782-2229
Provider Business Practice Location Address Fax Number:
401-782-2555
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT01570 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT01570 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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