Healthcare Provider Details

I. General information

NPI: 1093271454
Provider Name (Legal Business Name): STEPHEN HENNINGER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 ROGERS RD STE 220
SAN ANTONIO TX
78251-3688
US

IV. Provider business mailing address

12508 JONES MALTSBERGER RD STE 110
SAN ANTONIO TX
78247-4215
US

V. Phone/Fax

Practice location:
  • Phone: 210-585-4270
  • Fax:
Mailing address:
  • Phone: 888-590-4002
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1315663
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: