Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 103684 | MN |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 5101018506 | MI |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 51136 | MN |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OL20000101 | WA |
N | 2081S0010X | Sports Medicine | 5101018506 | MI |
N | 213ES0000X | Sports Medicine | 5101018506 | MI |
Y | 2081S0010X | Sports Medicine | OP00002223 | WA |
Y | 213ES0000X | Sports Medicine | OP00002223 | WA |
NPI | 1013017060 |
---|---|
Provider Name | Phillip Troy Henning |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-5698 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 01/03/2021 |