Provider Demographics
NPI:1437390630
Name:HENEGAR, NEAL GALEN (LMT)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:GALEN
Last Name:HENEGAR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FAIRWAY DR.
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176
Mailing Address - Country:US
Mailing Address - Phone:386-334-3688
Mailing Address - Fax:
Practice Address - Street 1:195 COQUINA COURT
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176
Practice Address - Country:US
Practice Address - Phone:386-334-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist