Individual
SALLY A BRENNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
45 MERIDEN AVE, SOUTHINGTON, CT 06489-3214
(860) 378-1234
Mailing address
421 WIGWAM RD, KENSINGTON, CT 06037-1703
(860) 828-0758
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0004474
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080004474CT01
BCBS
CT
01
—
11241398
CAQH
CT
Enumeration date
03/16/2007
Last updated
07/08/2007
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