Healthcare Provider Details

I. General information

NPI: 1831255322
Provider Name (Legal Business Name): MICHAEL D HENKELMAN PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S ORLANDO AVE STE H
WINTER PARK FL
32789-7102
US

IV. Provider business mailing address

2628 ALCLOBE CIR
OCOEE FL
34761-8967
US

V. Phone/Fax

Practice location:
  • Phone: 407-628-5500
  • Fax: 407-628-5505
Mailing address:
  • Phone: 407-578-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 0009941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: