Provider Demographics
NPI:1851666465
Name:HENNIG, ELSIE ALLEN (LPTA)
Entity Type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:ALLEN
Last Name:HENNIG
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:BLYNKEN
Other - Middle Name:
Other - Last Name:HENNIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4420 17TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-2308
Mailing Address - Country:US
Mailing Address - Phone:703-522-2639
Mailing Address - Fax:
Practice Address - Street 1:10701 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6904
Practice Address - Country:US
Practice Address - Phone:703-273-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001763225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant