Individual
DOUGLAS A HENNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-9261
(217) 258-2530
(217) 258-4176
Mailing address
1000 HEALTH CENTER DR, MATTOON, IL 61938-9261
(217) 258-2530
(217) 258-4176
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070023698
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070023698
—
IL
Enumeration date
05/21/2019
Last updated
05/21/2019
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