Healthcare Provider Details

I. General information

NPI: 1518946375
Provider Name (Legal Business Name): LAURA MARIE HENNINGER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MARIE ROBINSON PT

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 LINCOLN AVE. SUITE 107
N. CHARLEROI PA
15022-2451
US

IV. Provider business mailing address

625 LINCOLN AVE. SUITE 209
N. CHARLEROI PA
15022-2451
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-4886
  • Fax: 724-483-0519
Mailing address:
  • Phone: 724-483-2159
  • Fax: 724-489-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 006114L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: