Provider Demographics
NPI:1891849659
Name:HENNIG, DAVID KENNETH (LMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KENNETH
Last Name:HENNIG
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 1:1109 NW 36TH ROAD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609
Mailing Address - Country:US
Mailing Address - Phone:352-372-6918
Mailing Address - Fax:
Practice Address - Street 1:1109 NW 36TH ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609
Practice Address - Country:US
Practice Address - Phone:352-372-6918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37487225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2552OtherBCBS