Brandon Michael Pennings, ATC, LAT
Specialist/Technologist, Athletic Trainer in Denmark, WI. Individual provider (NPI-1).
NPI number1215322011
StatusActive
Last updated in NPPESMar 30, 2015
Details
- NPI
- 1215322011
- Entity type
- Individual (NPI-1)
- Name
- Brandon Michael Pennings
- Credential
- ATC, LAT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 30, 2015
- Last updated
- Mar 30, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 2000019385 | WI | Yes |
Practice location
224 Wisconsin AveDenmark, WI 54208-9737
Phone 920-713-0702
Mailing address
224 Wisconsin AveDenmark, WI 54208-9737
Phone 920-713-0702
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