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NPI Code Detail

MEDICARE: ANTHONY R BRENNEKE MPT

MEDICARE: ANTHONY R BRENNEKE MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2006024759MO

General Provider Information

NPI Number : 1457757940
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY R BRENNEKE MPT
Provider Business Mailing Address
First Line : 3600 COUNTRY CLUB DR
Second Line : STE 530B
City : JEFFERSON CITY
State : MO
Zip : 65109-1060
Country : US
Telephone Number : 573-606-7100
Fax Number : 573-681-0445
Provider Business Practice Location Address
First Line : 3600 COUNTRY CLUB DR
Second Line : STE 530B
City : JEFFERSON CITY
State : MO
Zip : 65109-1060
Country : US
Telephone Number : 573-606-7100
Fax Number : 573-681-0445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2014
Last Update Date : 05/23/2022

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