Healthcare Provider Details

I. General information

NPI: 1124613658
Provider Name (Legal Business Name): HENRY KHOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 03/06/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 LOMBARD ST
PHILADELPHIA PA
19146-1625
US

IV. Provider business mailing address

200 TINA DR
LANGHORNE PA
19047-5775
US

V. Phone/Fax

Practice location:
  • Phone: 215-546-5960
  • Fax:
Mailing address:
  • Phone: 215-605-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT029149
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: