| Doctor Name: | LYNAE MARIE HENINGER |
| NPI Number: | 1508164039 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT, CSCS |
| License Number: | 1974 |
| Business Practice Address: | 3035 W Mcmillan Rd Suite 104 Meridian, ID - 836466291 |
| Business Phone Number: | 2088878684 |
| Business Fax Number: | 2088879226 |
| Mailing Address: | 3035 W Mcmillan Rd, Suite 104 MERIDIAN |
| State: | ID |
| Postal Code: | 836466291 |
| Phone Number: | 2088878684 |
| Fax Number: | 2088879226 |
| NPI Enumeration Date: | 03/08/2011 |
| NPI Last Update Date: | 08/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1974 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |