Healthcare Provider Details

I. General information

NPI: 1164731642
Provider Name (Legal Business Name): MAURA TEHRANI HENDERSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 MYSTIC LN
MALVERN PA
19355-1942
US

IV. Provider business mailing address

12 MYSTIC LN
MALVERN PA
19355-1942
US

V. Phone/Fax

Practice location:
  • Phone: 610-956-9567
  • Fax: 610-910-3501
Mailing address:
  • Phone: 610-956-9567
  • Fax: 610-910-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020995
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: