Provider Demographics
NPI:1013094473
Name:HENERT, ROBERT J (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:HENERT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1121 W WARNER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2819
Mailing Address - Country:US
Mailing Address - Phone:480-763-5950
Mailing Address - Fax:480-763-1375
Practice Address - Street 1:15410 S MOUNTAIN PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6691
Practice Address - Country:US
Practice Address - Phone:480-940-8299
Practice Address - Fax:480-704-0888
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2670225100000X
2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic