Active NPI
Angela Brenner, PT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1417233297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13436
- Practice address
- 3944 San Augustine Way
San Diego, CA 92130-2260 - Phone
- (858) 793-4496
- Fax
- (858) 793-5461
- NPI assigned
- Oct 25, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 13436 | CA | Primary |
Addresses
Primary practice location
3944 San Augustine Way
San Diego, CA 92130-2260
Mailing address
3944 San Augustine Way
San Diego, CA 92130-2260
Phone (858) 793-4496
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13436 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319500800000",
"number": "1417233297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3944 SAN AUGUSTINE WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302260",
"telephone_number": "858-793-4496",
"fax_number": "858-793-5461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3944 SAN AUGUSTINE WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921302260",
"telephone_number": "858-793-4496",
"fax_number": "858-793-5461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNER",
"first_name": "ANGELA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-25",
"last_updated": "2011-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "13436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.