MEDICARE: NATHAN HENKE

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	225200000X	Physical Therapy Assistant	A2215	MN
2	225200000X	Physical Therapy Assistant	A2240	MN

General Provider Information

NPI Number	:	1841859154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN HENKE

Provider Business Mailing Address
First Line	:	3340 PORTAGE CIR NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-5689
Country	:	US
Telephone Number	:	612-756-4605
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 HIGHWAY 52 N
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-7657
Country	:	US
Telephone Number	:	507-429-3624
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	07/28/2021

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Directions to “ NATHAN HENKE ” Practice Location

Language	Start Address	Practice Location

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