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NPI Code Detail

MEDICARE: MARYANNE HENDERSON

MEDICARE: MARYANNE HENDERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation PhysicianOS007476LPA

General Provider Information

NPI Number : 1679571699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYANNE HENDERSON
Provider Business Mailing Address
First Line : 1405 SHADY AVE
Second Line : SUITE G-103 BUILDING D
City : PITTSBURGH
State : PA
Zip : 15217-1350
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1405 SHADY AVE
Second Line : SUITE G-103 BUILDING D
City : PITTSBURGH
State : PA
Zip : 15217-1350
Country : US
Telephone Number : 412-420-2270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 03/25/2021

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Directions to “ MARYANNE HENDERSON ” Practice Location

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