MEDICARE: ANGELA KAYE HENRY PT

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
1	225100000X	Physical Therapist	03520	IA

General Provider Information

NPI Number	:	1710212261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KAYE HENRY PT

Provider Business Mailing Address
First Line	:	205 W WACKER DR
Second Line	:	SUITE 1020
City	:	CHICAGO
State	:	IL
Zip	:	60606-1216
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:	312-640-0407

Provider Business Practice Location Address
First Line	:	124 WEST MISSION STREET
Second Line	:
City	:	STRAWBERRY POINT
State	:	IA
Zip	:	52076-0000
Country	:	US
Telephone Number	:	563-933-2130
Fax Number	:	563-933-6133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	03/15/2012

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