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General NPI Number Information
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NPI Number | 1386614865
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Entity Type | Individual
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Provider Name | WAYNE HENNEN RPT
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 900 2ND AVE
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City | MADISON
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State | MN
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Zip | 56256-1006
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Country | US
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Telephone | 320-598-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 500 CROSS ST
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City | BIG STONE CITY
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State | SD
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Zip | 57216-8237
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Country | US
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Telephone | 605-541-1140
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Fax | 605-541-0109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 625
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5338
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License Number State | MN
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