Individual
GRACE R MATOS-BRENNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1227-7 MONTAUK HIGHWAY, OAKDALE, NY 11769
(631) 218-1545
Mailing address
PO BOX 726, STONY BROOK, NY 11790-0726
(631) 474-3652
(631) 474-7893
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
5729
NY
Other
Enumeration date
02/13/2007
Last updated
07/08/2007
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