person
Mr. Henderson B Brenner III, PT
Military Health Care Provider in Fort Eustis, Virginia
NPI 1598742694

Henderson B Brenner III is a Military Health Care Provider based in Newport News, VA. Henderson B Brenner III practices in Fort Eustis, VA and has the professional credentials of PT. The NPI Number for Henderson B Brenner III is 1598742694 and holds a License No. 1109718 (Virginia).

The current practice location address for Henderson B Brenner III is 576 Jefferson Ave, Fort Eustis, VA and can be reached out via phone at 757-314-7500.

Location: 576 Jefferson Ave, Fort Eustis, VA, 23601-1004
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Provider Profile Details
NPI Number
1598742694
Provider Name
Henderson B Brenner III
Credential
PT
Provider Entity Type
Individual
Gender
Male
Address
576 Jefferson Ave, Fort Eustis, VA, 23601-1004
Phone Number
757-314-7500
Fax Number
Provider Enumeration Date
12/29/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1109718 01 TX PHYSICAL THERAPY LICENSE
institution
Provider Business Practice Location Address Details
Address
576 Jefferson Ave
City
State
Zip
23604-1602
Phone Number
757-314-7500
Fax Number
person
Provider Business Mailing Address Details
Address
576 Jefferson Ave
City
State
Zip
23604-1602
Phone Number
757-314-7500
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
License No.
1109718 (Texas)
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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