Provider Demographics
NPI:1376230029
Name:HENNING, CAITLIN PATRICIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:PATRICIA
Last Name:HENNING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 MAGNOLIA TREE LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6504
Mailing Address - Country:US
Mailing Address - Phone:757-404-5561
Mailing Address - Fax:
Practice Address - Street 1:2600 CROASDAILE FARM PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1331
Practice Address - Country:US
Practice Address - Phone:919-384-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist