Individual
BENJAMIN JOHN BRENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
205 OAK ST, TURTLE LAKE, WI 54889-8929
(715) 986-2022
(715) 986-2236
Mailing address
1110 7TH AVE, CUMBERLAND, WI 54829-9138
(715) 822-6167
(715) 822-6142
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5791-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40314000
MEDICAL ASSISTANCE
WI
05
—
84587-0007
—
WI
Enumeration date
03/23/2006
Last updated
07/09/2012
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