Healthcare Provider Details

I. General information

NPI: 1497886022
Provider Name (Legal Business Name): NATALIE R HENNING P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 CHANTILLY DR
HOUMA LA
70360-7129
US

IV. Provider business mailing address

1612 CHANTILLY DR
HOUMA LA
70360-7129
US

V. Phone/Fax

Practice location:
  • Phone: 504-234-0974
  • Fax:
Mailing address:
  • Phone: 504-234-0974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number04211
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number04211
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: