Individual
DR. BRANDIE JACKSON TENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
771 PILOT HOUSE DRIVE, NEWPORT NEWS, VA 23606
(757) 873-2123
(757) 873-3848
Mailing address
3902 ROCHAMBEAU DR, WILLIAMSBURG, VA 23188-6620
(757) 707-0945
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305203940
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010105536
—
VA
01
—
7709582
AETNA
—
01
—
P00140465
RAILROAD MEDICARE
VA
Enumeration date
04/05/2006
Last updated
02/04/2021
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