Provider Demographics
NPI:1376539627
Name:HENZLER, DAVID WERNER (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WERNER
Last Name:HENZLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-0883
Mailing Address - Country:US
Mailing Address - Phone:845-226-1171
Mailing Address - Fax:845-226-3462
Practice Address - Street 1:985 ROUTE 376
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6377
Practice Address - Country:US
Practice Address - Phone:845-226-1171
Practice Address - Fax:845-226-3462
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY95271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
886740OtherAETNA US HEALTHCARE
10081386OtherCDPHP
1375474OtherUNITED HEALTHCARE
0201201OtherAETNA ORTHONET
P480277OtherOXFORD
713310OtherMVP
19433OtherBLUE SHIELD NE NY
0201201OtherAETNA ORTHONET
1375474OtherUNITED HEALTHCARE