Healthcare Provider Details

I. General information

NPI: 1356330575
Provider Name (Legal Business Name): ANTOINETTE (TONI) BLANCHE BRINKER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 45011, BLDG 704, ATTN: MCJA-QM USA MEDICAL DEPARTMENT ACTIVITY, JAPAN
APO AP
96338-5011
JP

IV. Provider business mailing address

UNIT 45011, BLDG 704, ATTN: MCJA-QM USA MEDICAL DEPARTMENT ACTIVITY, JAPAN
APO AP
96338-5011
JP

V. Phone/Fax

Practice location:
  • Phone: 011813117638206
  • Fax: 011813117638183
Mailing address:
  • Phone: 011813117638206
  • Fax: 011813117638183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8826
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: