Provider Demographics
NPI:1003390667
Name:HENNINGSEN, CHRISTIAN ANTHONY (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ANTHONY
Last Name:HENNINGSEN
Suffix:
Gender:M
Credentials:DPT
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Mailing Address - Street 1:9700 DE SOTO AVENUE
Mailing Address - Street 2:ATTN: DR. CHRISTIAN HENNINGSEN, PT, DPT
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311
Mailing Address - Country:US
Mailing Address - Phone:818-882-8100
Mailing Address - Fax:818-700-8255
Practice Address - Street 1:9700 DE SOTO AVENUE
Practice Address - Street 2:ATTN: DR. CHRISTIAN HENNINGSEN, PT, DPT
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311
Practice Address - Country:US
Practice Address - Phone:818-882-8100
Practice Address - Fax:818-700-8255
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT295563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225100000XMedicaid