Basic Information
| Provider Information | |||||||||
| NPI: | 1386631620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINRICHSEN | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 FISHER STREET, ROOM 1A-132 | ||||||||
| Address2: | 81 MSGS/SGCUY | ||||||||
| City: | KEESLER AFB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283760446 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 FISHER ST RM 1A-132 | ||||||||
| Address2: | 81 MSGS/SGCUY | ||||||||
| City: | KEESLER AFB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395342508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283760446 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 11/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.