Provider Demographics
NPI:1083446967
Name:HENTENAAR, WILLIAM (DPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HENTENAAR
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 1:59 JAMES ST APT B
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1245
Mailing Address - Country:US
Mailing Address - Phone:315-400-9245
Mailing Address - Fax:
Practice Address - Street 1:1 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3265
Practice Address - Country:US
Practice Address - Phone:607-758-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist