Provider Demographics
NPI:1528414562
Name:HENNIG, BRIAN ALLEN
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ALLEN
Last Name:HENNIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA PUGET SOUND HEALTH CARE SYSTEM
Mailing Address - Street 2:9600 VETERANS DRIVE SOUTHWEST
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0001
Mailing Address - Country:US
Mailing Address - Phone:253-583-1261
Mailing Address - Fax:253-589-4112
Practice Address - Street 1:VA PUGET SOUND HEALTH CARE SYSTEM
Practice Address - Street 2:9600 VETERANS DRIVE SOUTHWEST
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-583-1261
Practice Address - Fax:253-589-4112
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner