Individual
MR. HENDERSON B BRENNER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
576 JEFFERSON AVE, FORT EUSTIS, VA 23604-1602
(757) 314-7500
Mailing address
950 J CLYDE MORRIS BLVD, STE 102, NEWPORT NEWS, VA 23601-1004
(469) 569-9407
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
1109718
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1109718
PHYSICAL THERAPY LICENSE
TX
Enumeration date
12/29/2005
Last updated
07/08/2007
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