MEDICARE: HEATHER HENNIGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT017593	OH

General Provider Information

NPI Number	:	1881404655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER HENNIGER

Provider Business Mailing Address
First Line	:	12301 SNOW RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-1002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 EAGLE VALLEY CT STE 204
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2982
Country	:	US
Telephone Number	:	440-592-6021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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Directions to “ HEATHER HENNIGER ” Practice Location

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