Provider Demographics
NPI:1194186569
Name:HENAHAN, MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HENAHAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 MCALPINE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1104
Mailing Address - Country:US
Mailing Address - Phone:570-842-9323
Mailing Address - Fax:570-842-9362
Practice Address - Street 1:824 MCALPINE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-1104
Practice Address - Country:US
Practice Address - Phone:570-842-9323
Practice Address - Fax:570-842-9362
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist