Provider Demographics
NPI:1740829704
Name:HENIGAR, VICKY LYNN (PTA)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:HENIGAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 988
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34441-0988
Mailing Address - Country:US
Mailing Address - Phone:352-212-6248
Mailing Address - Fax:
Practice Address - Street 1:4865 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8168
Practice Address - Country:US
Practice Address - Phone:352-746-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-22
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA13552225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant