Healthcare Provider Details

I. General information

NPI: 1386631620
Provider Name (Legal Business Name): LEE CHARLES HINRICHSEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST RM 1A-132 81 MSGS/SGCUY
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

301 FISHER STREET, ROOM 1A-132 81 MSGS/SGCUY
KEESLER AFB MS
39534
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-0446
  • Fax:
Mailing address:
  • Phone: 228-376-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: