Provider Demographics
NPI:1922138189
Name:DANNENBAUM, JOSEPH HENRY III (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HENRY
Last Name:DANNENBAUM
Suffix:III
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX D10
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77844-9040
Mailing Address - Country:US
Mailing Address - Phone:979-691-0620
Mailing Address - Fax:
Practice Address - Street 1:TAMU MS 4243
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-4243
Practice Address - Country:US
Practice Address - Phone:979-862-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT36372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer