Active NPI
Brenna K Timmick, DPT
- Physical Therapist
- Evans Mills, NY
National Provider Identifier
1457750648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 039554-1
- Practice address
- 25600 Nys Route 342
Ste. C & D
Evans Mills, NY 13637-3256 - Phone
- (315) 221-5101
- NPI assigned
- Aug 14, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10169 | TN | |
| Physical Therapist | 225100000X | 039554-1 | NY | Primary |
Addresses
Primary practice location
25600 Nys Route 342
Ste. C & D
Evans Mills, NY 13637-3256
Mailing address
111 Wendell LN
Black River, NY 13612-2111
Phone (610) 724-0834
Other names 1
- Brenna K Keane
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 |
|---|---|---|---|
| 039554-1 | NY | MD | Physical Therapist |
| 10169 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455840000000",
"number": "1457750648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 WENDELL LN",
"city": "BLACK RIVER",
"state": "NY",
"postal_code": "136122111",
"telephone_number": "610-724-0834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25600 NYS ROUTE 342",
"address_2": "STE. C & D",
"city": "EVANS MILLS",
"state": "NY",
"postal_code": "136373256",
"telephone_number": "315-221-5101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIMMICK",
"first_name": "BRENNA",
"middle_name": "K",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-14",
"last_updated": "2016-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "10169",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "039554-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRENNA",
"last_name": "KEANE",
"middle_name": "K",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Evans Mills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.