Drew Henneberg
Individual provider Active NPI Physical Therapist · Bloomington, IL
NPI 1992129647 · NPPES record last updated Feb 14, 2014
Key facts
- NPI
- 1992129647
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070-020031 (IL)
- Practice address
- 135 N Williamsburg Dr
Bloomington, IL 61704-3528 - Phone
- (309) 661-8823
- Fax
- (309) 661-8801
- NPI assigned
- Feb 14, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200625002100 | IL | Practitioner - Physical Therapist in Private Practice | 1658793336 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illinois Centers for Pain and Rehab, SC | Current |
Accepting new patients | |
| Orthopedic and Sports Enhancement Center, LLC | Current |
Accepting new patients |
Locations
2406 E Empire St
Bloomington, IL 61704
Phone (309) 662-4321
3400 Griffin Ave
Pekin, IL 61554
Phone (309) 244-7700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-020031 | IL | Yes |
Addresses
Primary practice location
135 N Williamsburg Dr
Bloomington, IL 61704-3528
Mailing address
135 N Williamsburg Dr
Bloomington, IL 61704-3528
Phone (309) 661-8823
Other providers in Bloomington, IL
- Julie R Heisel-Wolter
- Carrie Lynne Helle
- Elizabeth Helton
- Jessica Anne Helton
- Beau Hendren-Santiago
- Jennifer Henneberg
- Heritage Enterprises, Inc
- Heritage Enterprises, Inc.
- Heritage Manor - Bloomington, LLC
- Heritage Manor - Lasalle, LLC
All providers in Bloomington, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2014. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.