Provider Demographics
NPI:1497188643
Name:HENTZEN, ANTHONY J (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:HENTZEN
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 1:607 DEWEY NWAVE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-7335
Mailing Address - Country:US
Mailing Address - Phone:913-904-1128
Mailing Address - Fax:
Practice Address - Street 1:1021 S 178TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3574
Practice Address - Country:US
Practice Address - Phone:402-933-3036
Practice Address - Fax:402-933-3163
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist