Healthcare Provider Details

I. General information

NPI: 1295065514
Provider Name (Legal Business Name): GAIL HENN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INTERNATIONAL PKWY SUITE 300
LAKE MARY FL
32746-5061
US

IV. Provider business mailing address

774 WHITE BIRCH RD
TOWNSHIP OF WASHINGTON NJ
07676-4237
US

V. Phone/Fax

Practice location:
  • Phone: 800-806-6026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00984800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: