Douglas R Henneberg, ATC
Physical Medicine & Rehabilitation, Sports Medicine in Rochester, NY. Individual provider (NPI-1).
NPI number1164096962
StatusActive
Last updated in NPPESMay 17, 2021
Details
- NPI
- 1164096962
- Entity type
- Individual (NPI-1)
- Name
- Douglas R Henneberg
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 17, 2021
- Certification date
- May 17, 2021
- Last updated
- May 17, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2081S0010X | Physical Medicine & Rehabilitation, Sports Medicine | 001092 | NY | Yes |
Practice location
1000 E Henrietta RdRochester, NY 14623-5701
Phone 585-292-2848
Mailing address
1000 E Henrietta RdRochester, NY 14623-5701
Phone 585-292-2848
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