Provider Demographics
NPI:1891500096
Name:HENNIGAR, ALEXIS (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:HENNIGAR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:WALRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3570 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-9753
Mailing Address - Country:US
Mailing Address - Phone:319-795-8627
Mailing Address - Fax:
Practice Address - Street 1:1301 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-4336
Practice Address - Country:US
Practice Address - Phone:319-520-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist