Provider Demographics
NPI:1447807797
Name:BRENNAN, TARA (PT, DPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
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 1:1500 JACKSON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3250
Mailing Address - Country:US
Mailing Address - Phone:281-344-8900
Mailing Address - Fax:281-344-8926
Practice Address - Street 1:1500 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3250
Practice Address - Country:US
Practice Address - Phone:281-344-8900
Practice Address - Fax:281-344-8926
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1323767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist