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General NPI Number Information
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NPI Number | 1003421355
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Entity Type | Individual
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Provider Name | JACOB J BRENNER III DPT
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Gender | Male
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 167 N MAIN ST
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City | AMHERST
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State | WI
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Zip | 54406-9028
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Country | US
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Telephone | 715-529-3424
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Fax | 715-251-6236
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Provider Business Mailing Address
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Address Line | PO BOX 324
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City | AMHERST
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State | WI
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Zip | 54406-0324
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Country | US
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Telephone | 715-529-3424
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Fax | 715-251-6236
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | WI
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