Provider Demographics
NPI:1548707953
Name:HENIGAN, BETH (DPT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:HENIGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 PARKS RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:MI
Mailing Address - Zip Code:48027-3206
Mailing Address - Country:US
Mailing Address - Phone:586-344-8939
Mailing Address - Fax:
Practice Address - Street 1:14901 23 MILE RD STE C
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3009
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:586-566-5816
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist