Provider Demographics
NPI:1871288530
Name:BRENNAN, HOLLY MAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MAY
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 1:28 GOLDENRAIN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2119
Mailing Address - Country:US
Mailing Address - Phone:949-922-9698
Mailing Address - Fax:
Practice Address - Street 1:3745 W CHAPMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1656
Practice Address - Country:US
Practice Address - Phone:949-922-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist