Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 009097-1 | NY |
N | 2251S0007X | Physical Therapist - Sports | 009097-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 009097-1 | NY |
NPI | 1184711970 |
---|---|
Provider Name | Diane L. Brennan |
First Address | Depew, NY 14043-1024 |
Second Address | Depew, NY 14043-1024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 16/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00011185701 | UNIVERA HEALTHCARE ID (01) | NY |
000611533001 | BLUE CROSS BLUE SHIELD ID (01) | NY |
9390415 | INDEPENDENT HEALTH ID (01) | NY |