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General NPI Number Information
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NPI Number | 1881404655
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Entity Type | Individual
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Provider Name | HEATHER HENNIGER
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Gender | Female
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1 EAGLE VALLEY CT STE 204
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-2982
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Country | US
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Telephone | 440-592-6021
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Fax |
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Provider Business Mailing Address
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Address Line | 12301 SNOW RD
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City | CLEVELAND
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State | OH
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Zip | 44130-1002
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Country | US
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Telephone |
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Fax |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT017593
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License Number State | OH
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