Provider Demographics
NPI:1104170497
Name:HENNINGER, ANGELINA L (DPT)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:L
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:L
Other - Last Name:DELIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
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:2012-11-08
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA260615R9XMedicare Oscar/Certification