Basic Information
| Provider Information | |||||||||
| NPI: | 1992444848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WETTER | ||||||||
| FirstName: | BRENNAN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5220 SW 17TH ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666042514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852715533 | ||||||||
| FaxNumber: | 7852718818 | ||||||||
| Practice Location | |||||||||
| Address1: | 5220 SW 17TH ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666042514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852715533 | ||||||||
| FaxNumber: | 7852718818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 1403738 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.