MARK BRENNER (NPI# 1558764365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558764365 |
| Entity Type | Individual |
| Full Name | MARK BRENNER |
| Practice Address |
736 Broadway Physical Therapy Fargo ND 58102-1031 |
| Mailing Address |
4115 17th St S Fargo ND 58104-6355 |
| Practice Telephone | 7012346738 |
| Practice Fax Number | 7012347452 |
| Mailing Telephone | 7012346738 |
| Mailing Fax Number | 7012347452 |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2014-10-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
0818 | ND | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386797355 | Mark Jeffery Brenner | Social Worker | 1 Nathaniel Way, Canton, MA 02021-3852 | 2007-01-20 |
| 1902873409 | Mark J Brenner | Radiology | 20 Washington Sq, Worcester, MA 01604-4013 | 2006-03-02 |
| 1750532388 | Mark Brenner | Physical Therapist | 7000 W Camino Real, Suite 240, Boca Raton, FL 33433-5532 | 2008-10-01 |
| 1013092162 | Mark Anthony Brenner | Chiropractor | 2380 Troop Drive, Suite 201, Sartell, MN 56377-4637 | 2006-10-26 |
| 1750390456 | Mark Brenner | Urology | 2946 E Banner Gateway Drive, Gilbert, AZ 85234 | 2006-08-05 |
| 1184631335 | Mark Earl Brenner | Orthopaedic Surgery | 5 Firstvillage Drive, Pinehurst, NC 28374 | 2006-08-01 |
| Street Address |
736 BROADWAY PHYSICAL THERAPY |
| City | FARGO |
| State | ND |
| Zip Code | 58102-1031 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588175061 | Total Balance Physical Therapy and Fitness, LLC | Physical Therapist | 1461 Broadway N Ste 106, Fargo, ND 58102-2622 | 2017-10-23 |
| 1720637630 | Samantha Jo Spaeth | Physical Therapist | 1461 Broadway N, Fargo, ND 58102-2622 | 2019-09-04 |
| 1841693579 | Shayne Marc Spokely | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-10-08 |
| 1821491614 | Scott Brown | Physical Therapist | 2990 Seter Pkwy S, Fargo, ND 58104-8692 | 2014-10-07 |
| 1942603279 | Brian Alan Skjerseth | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-10-01 |
| 1083017370 | Jennifer Lynn Lamp | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-10-01 |
| 1780087015 | Greg Grenz | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-10-01 |
| 1669875092 | James Henry Clapp | Physical Therapist | 736 Broadway N, Fargo, ND 58102-4421 | 2014-09-30 |
| 1275936809 | Karen Olson | Physical Therapist | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2014-09-26 |
| 1700094018 | Scott Brendan Nice | Physical Therapist | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2007-05-18 |
| Find all providers in FARGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.