Provider Demographics
NPI:1568895910
Name:HENNING, MARKUS JAMES (MPT)
Entity Type:Individual
Prefix:
First Name:MARKUS
Middle Name:JAMES
Last Name:HENNING
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4572 TELEPHONE RD
Mailing Address - Street 2:SUITE 903
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5662
Mailing Address - Country:US
Mailing Address - Phone:805-654-8127
Mailing Address - Fax:
Practice Address - Street 1:4572 TELEPHONE RD
Practice Address - Street 2:SUITE 903
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5662
Practice Address - Country:US
Practice Address - Phone:805-654-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist