Emily Henneman, PT
Individual provider Active NPI Physical Therapist · Arvilla, ND
NPI 1629756366 · NPPES record last updated Jul 11, 2023
Key facts
- NPI
- 1629756366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1699 (ND)
- Practice address
- 3362 15TH Ave NE
Arvilla, ND 58214-9410 - Phone
- (701) 270-0265
- NPI assigned
- Jul 11, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- University of Minnesota Medical School, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Home Therapy Solutions LLC
Practice addresses (Care Compare)
Thompson, ND 58278
Phone (701) 554-0111
39725 255TH St SW
Fisher, MN 56723-9352
Phone (218) 230-2171
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230804003539 | ND | Practitioner - Physical Therapist in Private Practice | 2961863030 | Reassigns benefits to 1 organization |
| I20230821003226 | MN | Practitioner - Physical Therapist in Private Practice | 2961863030 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1699 | ND | MD | Dentist |
| 9195 | MN | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Home Therapy Solutions LLC | Physical Therapist | Current |
Accepting new patients |
Locations
749 S 30th St
Apt 23
Grand Forks, ND 58201
Phone (218) 230-2171
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 1699 | ND | |
| Physical Therapist | 225100000X | 1699 | ND | Yes |
Addresses
Primary practice location
3362 15TH Ave NE
Arvilla, ND 58214-9410
Mailing address
3362 15TH Ave NE
Arvilla, ND 58214-9410
Phone (701) 270-0265
Other providers in Arvilla, ND
All providers in Arvilla, ND · Physical Therapist in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.