Provider Demographics
NPI:1811241268
Name:HENNINGER, MATHEW R (DPT)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:R
Last Name:HENNINGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 YATES ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17065-1019
Mailing Address - Country:US
Mailing Address - Phone:717-462-7606
Mailing Address - Fax:717-458-1559
Practice Address - Street 1:311 S WEST ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3854
Practice Address - Country:US
Practice Address - Phone:717-462-7606
Practice Address - Fax:717-458-1559
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist